gms | German Medical Science

Background: A complete and actual medication plan is one of the most important factors for patient safety [1]. An optimal medication plan can increase medication therapy safety significantly, especially in patients with polypharmacy (≥5 systemic medications). It exists with the "Aktionsplan AMST 2010-2012" issued by the German Government a standardised medication plan but there is still no explicit information how far medication plans are used [2]. The "Landesgesundheitskonferenz NRW" defined optimising these plans as a key role for community pharmacies [3]. By this time it is not evaluated what the main issues and sources of misunderstanding with medication plans are and how pharmacists can improve the quality of these plans. Therefore it is necessary to assess the quality of medication plans, to define the areas of concern and the potentials for improvement.

Materials and Methods: Aim of the project was to assess discrepancies between the existing medication plans and current pharmacotherapy and to evaluate the quality of these plans with predefined quality indicators, derived from the medication plan template published by the "Aktionsplan AMST 2010–2012". With these data possible assignments for pharmacists can be identified how to improve medication therapy safety through actual medication plans.

During the Apo-AMST course pharmacists and pre-registration students conducted, with a convenience sample of 100 patients, intermediate medication reviews. Inclusion criteria for the patients were the regularly intake/application of ≥5 systemic medication over the last 6 month according to pharmacy data. The reviews were performed based on recorded data in the pharmacy, a brown-bag-review and a structured patient interview. Based in these data the patients` current pharmacotherapy was compared to the patient`s medication list. Existence, completeness and discrepancies was evaluated. Additionally the quality was assessed based on pre-defined quality data derived from the medication plan template from the Aktionsplan AMTS 201-2012. All information was transferred into an evaluation sheet and sent to the Apo-AMTS coordinator together with a copy of the plan. The data was evaluated with Exel 2007.

Results: From 100 patients with an average age of 72 years, (SD 12; range 42–95) 87 where provided with a plan. From these 87, 47 were female and 40 male. The different plans where written by relatives (9; average age 76, SD 12; 52–88), patients (21, average age 66, SD 13; 44–85), medical specialists (8, average age 75, SD 10; 56–83) and general practitioners (49, average age 76, SD 10; 46–95).

On the plans in median 8 (SD 3; 3-17) RX medications were listed, but only 37 plans (42.53%) showed OTC-drugs with a median number of 1 (SD 1; 1–5).

In regard to the quality indicators 72 plans (83%) included the name of the patient, 54 (62%) additionally the date of birth. Also 54 plans endowed an issue date. Only 24 plans (28%) had an issue date below 4 weeks, 7 (8%) were even older than 8 to 12 month. Not one plan showed all quality indicators, 54 plans (62%) included a dosage. Only 15 (17%) plans enclosed the galenic form, 4 (4.6%) comprised advices for intake and 3 (3%) showed an indication.

Only 6 plans (7%) showed no discrepancies according to number of medication, dosage, strength or name of the medication. 32 medications where listed on the plan but not taken (median 1, SD 1; 1–4), 14 (44%) from these drugs were cardiovascular drugs. 46 drugs were not listed but taken by the patients (median 2, SD 1,5, 1–8), here especially pain medication with 56 (52%). 21 drugs where taken in a higher than prescribed dose, 15 in a lower dose. In 145 cases (20%) the names of the RX-medication did differ. 82 OTC - drugs where not listed. Here especially pain medication with 20% magnesium products (9%) and laxatives (7%). With a complete number of 390 discrepancies 4.78 (SD 3.07) deviations in average per medication plan could be detected by pharmacists.

Conclusion: First results from the quality assessment showed that a medication plan alone is not enough to improve medication safety. Important quality indicators like the correct application or intake, the formulation and even dosages and strength are missing. These are issues where especially the community pharmacy can play an important role. Evaluating these plans with the patient are also helpful in explaining indications and reduce therefore discrepancies in the intake of live-saving drugs. Further investigation needs to be done to identify the patients with the highest risk for discrepancies on their medication lists and the impact of these discrepancies on their health.