gms | German Medical Science

Background: The study should descry whether the safety of pharmacotheray is of any difference between home care patients and those in in-patient facilities. The focal point lies in particular on the supply with PRISCUS pharmaceutical products, painkillers, psychotic drugs and the simultaneous use of more than five different drugs. The data collected included cost-, quantity- and price components.

It was expected that insured persons in in-patient care facilities receive pharmaceutical products with a high risk potential more often than insured persons in home care.

Materials and methods: The study collected data of persons insured by AOK-Rheinland older than 64 years of age who were treated in (number 33.136) or in in-patient facilities (number 31.923) in 2010. The pharmaceutical and medical analysizes were performed on the basis of the programs Prescription 300 and Specialized Proceedings of Doctors. For the analysis of the average values of prescriptions only patients who have received at least one drug prescription in 2010 (drug patients) were considered. For the evaluation only completed pharmaceutical products which have an ATC code or a DDD classification came into consideration.

Results: Both in the home and in-patient care deficiencies can be seen. About 80% of the over 64-old-patients in a nursing home and 74% in home care received 5 or more different drugs or drug combinations (ATC third level!). More than 10 different active ingredients or rather combinations of active ingredients were prescribed for over 10.000 insured persons in a nursing home.

In both groups PRISCUS pharmaceutical products – in particular psychotic drugs – were frequently prescribed. Antidepressant drugs for patients in nursing homes were mainly prescribed by neurologists (43%) while the prescription of those pharmaceutical products for home care patients was mainly be done by general practitioners (46%). X% of the patients were given codeine supplements.

The frequency of the prescription of psychotic drugs with a high risk of side effects (Metamizol/ Flupirtin) is also remakably noticable.

The realization of the WHO graduated scheme for the treatment of chronic pain was insuffient in both groups.

Conclusion: The results show that the optimization of the interdisciplinary collaboration of physicians, pharmacists and nursing home personnel needs to be encouraged. - for the care of patients in nursing homes as well as the the interface of the in-patient – out-patient network.

In regard of this study and in order to improve the safety of pharmacotherapy a reduction of prescribed active ingredients as well as psychotic drugs has to be asked for. A continuous review, adjustment of dosages and avoidance of prescription cascades (prescription = unwanted side effects = new disease/ symptoms = another drug) are necessary to provide an ideal pharmcotherapy in coordination of all professions involved in the therapy (Geriatric Medication Management).