gms | German Medical Science

21st Annual Meeting of the German Drug Utilisation Research Group (GAA), 9th German "Pharmakovigilanztag"

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie

20.11.-21.11.2014, Bonn

Aspects of the study design and preliminary results of the WestGem study: WESTphalian study on a medication therapy management and home care based intervention under Gender specific aspects in Elderly Multimorbid patients

Meeting Abstract

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 21. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie, 9. Deutscher Pharmakovigilanztag. Bonn, 20.-21.11.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. Doc14gaa07

doi: 10.3205/14gaa07, urn:nbn:de:0183-14gaa074

Published: November 18, 2014

© 2014 Rose et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Background: Medication Therapy Management (MTM) in 2014 is a new Service provided by German Pharmacists to Physicians and Patients. Despite sufficient international data [1], [2], there are only few and limited studies supporting the benefits of a MTM under German terms, most of them restricted to certain Pharmaceutical Care aspects or to simple or intermediate MTM. The WestGem-Study aimes to contribute data regarding quality of therapy, quality of life and expenses as major endpoints by intervening with an advanced clinical MTM in an interprofessional health-care-team setting.

Materials and Methods: Prospective, cluster-randomized, controlled Trial, stepped wedge study design

Inclusion criteria: Men and women over 65 years with three or more chronic diseases affecting at least two different organ systems and a cardiovascular background. Prescription of five or more systemic long-term medications.

Exclusion criteria: Life expectancy less than one year, no given informed consent.

166 Patients were recruited at 12 Primary Care Centres.

The Intervention is an advanced clinical MTM done and controlled by two specialized pharmacists, complemented by a support-plan of the patient-care-centre. The MTM is provided two times with 6 months between. Patient data is collected on six distinguished points before, during and after the interventions.

Results: Study results will be published in 2015.

Assorted preliminary data and results:

  • Median patient age: 77,2 y (male) and 78,5 y (female)
  • Morbitity. Most frequent diseases found were:
    • 90% Hypertonic disease
    • 60% Hyperlipidemia
    • 48% Diabetes mellitus Typ II
    • 44% CHD
    • 25% AFIB
    • 24% Lower back pain

Results are in accordance with previous population data [3].

Pharmacists found a deviation between prescription and medicine intake at home at 3,9 drugs for men and 4,9 drugs for women. 22% of this deviation was caused by OTC-selfmedication, others was on prescription drugs.

An average of 1,1 PRISCUS PIMs [4] was detected per patient. We found an average of 12 (male) to 13,95 (female) drug related problems (DRPs). 5,07 (male) to 6,23 (female) drug-drug interactions were detected, about one quater of These interactions was rated as 'clinical relevant'.

Conclusion: A serious deviation between the prescribed drugs and the patient intake at home is seen, which might have an impact on the therapeutic goals. Prescribing of potentially inadequate medicine in the elderly is common in the studied population. Several clinical relevant drug interactions and DRPs were found. The preliminary data supports the thesis that an interprofessional Medication Therapy Management can contribute to detect clinical relevant drug related Problems in an outpatient, community setting among the elderly.


References

1.
Isetts BJ, Brown LM, Schondelmeyer SW, Lenarz LA. Quality assessment of a collaborative approach for decreasing drug-related morbidity and achieving therapeutic goals. Arch Intern Med. 2003 Aug 11-25;163(15):1813-20.
2.
Isetts BJ, Schondelmeyer SW, Artz MB, et al. Clinical and economic outcomes of medication therapy management services: the Minnesota experience. J Am Pharm Assoc (2003). 2008 Mar-Apr;48(2):203-1.
3.
van den Bussche H, Koller D, Kolonko T, et al. Which chronic diseases and disease combinations are specific to multimorbidity in the elderly? Results of a claims data based cross-sectional study in Germany. BMC Public Health. 2011 Feb 14;11:101.
4.
Holt S, Schmiedl S, Thürmann PA. Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int. 2010 Aug;107(31-32):543-51.