gms | German Medical Science

Background: Due to demographic changes the number of patients increases. Hence the number of hospitalizations as well as the number of prescribed drugs increases, too. Outpatient drug prescription is affected by several rules as the social security code (SGB V). However these rules only have small influence on hospital discharge. Usually the patient’s medication is modified in the hospital and does not fulfill outpatient rules for cost effectiveness. The §115c SGB V contains rules for management of drugs discharge management.

We aimed to analyze prescription data of a large German health care insurance (AOK Nordost) to give an objective description of the hospital’s influence on costs and patients’ safety. Based on the results we aimed to develop adequate activities.

Materials and Methods: In Germany there is no standard for quality and cost measurement with routine data. Hence we used an older statistical algorithm which was developed by Grimmsmann et al. [1]. In the context of a local initiative in Mecklenburg western Pomerania we discussed the results with six selected hospitals. For data analysis we used routine data from 2012. Patients who were discharged from hospital were chosen. Prescribed drugs six months before and after hospital discharge were analyzed. The number of cases varied between 820 and 5604 p.a.. We analyzed the following parameter: gross costs, quantity of prescribed DDD, number of patients who received a drug, and number of different active substances (ATC).

Results: After hospital stay the gross costs for three months increase from 575,- € to 691,- € (mean: 19.2% MIN 8.4%; MAX 30.5%). The number of prescribed active substances increase about 7.6%. We found considerable increases in selected drug classes. Over all hospitals the number of prescribed proton pump inhibitors (PPI) grew between 13% and 24% (the number of patients who received PPI increased from 1039 to 1232). The prescription of direct oral anticoagulants varied considerably (mean increase: 238%). We also found considerable volume growth of me too drugs as tapentadol, duloxetine, pregabalin, paliperidone.

There was no statistical difference between small, large and university hospitals.

Conclusion: A part of volume increase is plausible and caused by morbidity. However, only some drugs were stopped after hospital discharge. Our discussions with the hospital doctors were positive. The doctors were thankful for transparency. We found inappropriate knowledge about outpatient rules for drug prescription.

The sector stratification of German health care system compromises communication and considerably affects patients’ safety. There is a need for a linked electronic prescription system and prescription of active substances instead of brand names. A clinical pharmacist can support medication process in the hospital. A follow up is planed.