gms | German Medical Science

Background: Inappropriate medication use in the community has been reported to be common particularly in patients taking multiple medications. It may lead to adverse drug reactions, medication-related hospital admissions and have been shown to be often preventable [1], [2]. One approach to minimize drug related problems (DRPs) is to do medication reviews by pharmacists. With the Apo-AMTS-Concept pharmacists and pre-registration students were taught how to conduct such reviews based on medication history and patient information (PCNE Guideline Intermediate level [3]).

Materials and Methods: In this cross-sectional study 855 medications from 76 patients documented by 21 pharmacists were chosen randomized from participants of the Apo-AMTS-Concept. In this concept pharmacists and pre-registration students received a 4 h basic course and a 3 day advanced course to get training in medication reviews. At the end of this training each participant had to review the medication of 5 patients in his pharmacy. DRPs had to be listed in a datasheet and interventions had to be documented. The classification of the detected problems was done by a modified MAI Sore [4]. A pharmacist with experience in medication records and a physician reviewed these datasheets. The ATC-code was used to categorize the different medications.

Results: Patients were aged between 42 and 92 years with a median of 72 years. For each patient 4-21 (median: 9) medication were documented. Medication was categorized in 169 medication of ATC-Code A, 308 of ATC-Code C, 134 of ATC-Code N, 54 of ATC-Code R. On the basis of the intermediate medication review pharmacists and students were able to document 354 drug related problems. The experts added 455 DRPs. Additionally drugs that have been shown to cause frequently adverse drug events like serotonin-reuptake inhibitors, beta-blockers and angiotensin-converting-enzyme inhibitors [1], were evaluated separately. The most sufficient documented problems by the trained group were side effects, problems with the time of intake, problems with the intake and adherence problems. Double medication, duration of intake and dosage intervals were the most overlooked or not assessed problems.

Conclusion: This study demonstrates that intermediate medication reviews done by pharmacists and pre-registration students after training have a positive impact in recognizing drug related problems. Pharmacists play an important role in detection of side effects, the correct handling of medication and the compliance of patient. Therefore recognizing these problems may improve the medical outcome of patient. It was difficult to recognize or assess DRPs like inappropriate dosage and double medication. The evaluation of these DRPs may be depended on a more detailed knowledge on the medical history of the patient and on more clinical experience. A higher support and training of pharmacists and students might be necessary for this.