gms | German Medical Science

Background: Old people often suffer from various chronic deseases which have to be treated according to the guidelines for pharmaceuticals. The complete medication of a patient isn't always known to the attending doctor because of the medication prescribed by his colleagues who are also treating this patient. Therefore undesirable side-effects of pharmaceuticals and pharmacological intersection can only be recognized and avoided with great difficulty.

Goal of this paradigm is the improvement and securing of the safety of pharmatherapy (AMTS) especially of elderly people aged over 65 years who have been permanently prescribed at least five different active pharmaceutical agents (API) for the period of one year. The risk of over-/under supply, pharmaceutical interactions as well as undesirable side-effects shall be reduced by refined and transparent analyses of complete presriptions. Providing the patient's approval these analyses will be placed at the disposal of the attending doctor in order to evaluate and coordinate the patient's entire medication. By this means an intersectoral communication and coordination between doctors of different branches will be supported and promoted. A long-term reduction of total costs (including hospital and care expenses) as a result of an improvement of the safety of pharmatherapy (AMTS) and of the quality of health care can be expected.

Materials and Methods: The pharmaceutical check is contractionally fixed as an add-on contract to the contracts with general practitioner concerning health care according to § 73 b SGB between the Association of Stationary Health Insurance Physicians (AHIP) Nordrhein respectively Hamburg and the AOK Rheinland/Hamburg. The procedure will be executed in two steps: In the first step the attending doctor will be requested in written term to get an approval from a patient chosen by the AOK Rheinland/Hamburg to take part in the pharmaceutical check. As a second step and in case of the patient's approval the attending doctor is given a substantial analyis of patient's medication including the medication prescribed by the colleagues treating the same patient. This analysis includes the colleagues name, address and specialization. Based on the analysis of the patient's complete prescriptions the attending doctor will evaluate the data and keep record of his gained insights and measures including if necessary the coordination of drug prescriptions on standardised documentation sheets. This also involves the recording of the OTC-medication which has to be requested from the patient. After all these sheets provide a basis for the billing of the doctor's fee. The contents of the documentation sheets will be integrated into the evaluation.

Results: So far the evaluation can only be descriptive because concerning the data of prescriptions after interventions an adequate reference period has to be taken in consideration. Until now in Nordrhein so-called “general reviews“ of 704 insured persons have been sent to 529 attending doctors. From these reviews 269 pharmaceutical checks based on the analysis of patient's the complete prescriptions have been executed. Which corresponds to a return rate of 38.21%. Up to now 303 „general reviews“ of insured persons have been sent to 156 general practitioners in Hamburg. For 144 insured persons a pharmaceutical checks have been carried out which corresponds to a return rate of 47.53%.

Conclusion: The acceptance to participate in the pharmaceutical checks of the AOK Rheinland/ Hamburg is high. If the evaluation shows that a procedure, carried out within the scope of pharmaceutical checks, and the editing of data improves the safety for pharmatherapy (AMTS), the insights gained can also be suitable for a realization on a broad and if need be electronic scale.