gms | German Medical Science

Introduction: Inappropriate drug use is a common problem for elderly multimorbid patients. Several studies in different countries (e.g. Australia, Great Britain) showed that Home Medication Reviews (HMR) could improve the health status of elderly people. The aim of this pilot study was to develop tools and to calculate expenditures for a Home Medication Review in Germany.

Methods: The HMR was conducted by 2 pharmacists and 7 physicians (6 general practitioners, 1 cardiologist) from 3 doctor’s practices.

• The pharmacists selected patients by diagnose and associated physician out of their database.
• Pharmacist and physician together generated a medication plan. Apart from the medication, this plan also contained clinical data and diagnoses. All prescribed drugs from other physician were included.
• The pharmacist visited patient at home. There he completed the medication plan during his HMR with all (self-) medication and devices, presented by patient. In addition all pills were counted.
• Drug-related problems and questions by patient were documented.
• All outcomes of the HMR were discussed with physician promptly.
• Based on the review of findings, physician and pharmacist designed a management plan with defined responsibilities in concordance with patient. The aim of this plan was an improvement of therapy.
• The pharmacist visited patient again after 6 month to evaluate results.

Results: 47 out of 50 patients (3 drop-outs) were visited two times with complete documentation (mean age 71.7, female 57.4%, male 42.6%, average number of diagnosis 6.8, average number of long term medication 8.8).

10 patients were advised to contact their physicians at once. There was no significant reduction in HbA1c for the whole group (7.8 to 7.7). Those 7 patients with the highest HbA1c (>9) showed a decrease of 0.9 [mean] =9%. The hypoglycaemia symptoms decreased from 57% to 39%. Knowledge and dealing with disease increased. Tools were developed and made available to the public.

Discussion and conclusion: A pharmacy and physician service model for multimorbid type 2 diabetic patients was successfully utilized. The practice research underlines the necessity of HMR as an intervention to increase the safety and efficiency of pharmacotherapy. Stepwise implementation should be realized.