Artikel
Overview on the results of the WestGem study – a 2016 update
Suche in Medline nach
Autoren
-
Olaf Rose
- Universität Bonn, Pharmazeutisches Institut, klinische Pharmazie, Bonn, Germany
-
Ulrich Jaehde
- Universität Bonn, Pharmazeutisches Institut, klinische Pharmazie, Bonn, Germany
-
Juliane Köberlein-Neu
- Universität Wuppertal, Bergisches Kompetenzzentrum für Gesundheitsökonomik und Versorgungsforschung, Wuppertal, Germany
| Veröffentlicht: | 23. November 2016 |
|---|
Gliederung
Text
Background: Medication Management is a rapidly evolving pharmaceutical-care service in Germany. International data on randomized controlled studies on Medication Management dates back as far as 1996 with a controlled study by Hanlon et al., removing inappropriate drugs from the therapeutic regimen [1]. Two decades later, several studies have been completed in diverse indications and settings [2], [3], [4], [5], [6], [7], [8], [9] and numerous reviews found beneficial aspects of Medication Management [10], [11], [12], [13]. The effects of Medication Management might depend on national characteristics of the health care system. For Germany, controlled data on Medication Management is scarce.
Materials and Methods: The WestGem-study was conducted in an outpatient primary care setting in North Rhine-Westphalia as a cluster randomized controlled trial, following a stepped wedge design. The intervention was a collaborative interprofessional Medication Management with general practitioners, pharmacists and health-care specialists in elderly multimorbid patients with polymedication. The primary endpoint was a change in the weighted summated MAI score [14], [15]. Secondary endpoints were a change in the number of drug-related problems, classified by the PCNE DRP classification system version 6.2 and a reduction of potential inappropriate medication. A Mixed Model, expanded by contrasts was created to detect the effect of the intervention. To find out whether certain patients had a major benefit of the intervention, the influence of several parameters on receiving a greater benefit status was analyzed in a multiple logistic regression model with backward selection. Changes in LDL-Cholesterol were analyzed comparing the levels before and after the interventions. Acceptance of the intervention was measured by feedback forms.
Results: 142 patients of 12 general practitioners were included in the study. Mean patient age was 76.7 years, 53.5% were female and a mean of 9.4 drugs were documented by the physician. The MAI score after intervention 1 was reduced from 29.21 to 22.27 by -6.94 or -4.51 if contrasts were added (95-%-[CI]: -6.66 – -2,36; p < 0,001). DRPs were reduced by -0,45 (-0,45, 95-%-KI: -0,81 – -0,09, p = 0,014). The reduction of PRISCUS-PIMs from 40 at study entry to 30 after the intervention was not significant. Multivariate regression on parameters that correlated to a major benefit from a Medication Management was significant for the baseline MAI score (p<0.001), the time of change from the control to the intervention group (p=0.006) and the discrepancy between prescribed and used drugs (p=0.009) (table 11). LDL-Cholesterol levels were reduced by -7.55 mg/dl (SD: 28.39) from 114.09 mg/dl (SD: 36.35) at baseline) to 106.54 mg/dl (SD: 35.8) after 15 months, with LOCF) (p = 0.012) (17). Acceptance analysis found that a total of 54.9% recommendations on pharmacotherapy were implemented by the physicians with 53.4% recommendations to stop a drug, 51.8% on starting the prescription of a new drug and 64.4% on changing a drug’s dose [16].
Conclusion: Study results lead to the conclusion that a collaborative Medication Management is effective in Germany. The significant reductions in the MAI score and in DRPs indicate an improved quality of medication therapy. LDL-Cholesterol reduction revealed only a trend but is an important parameter in cardiovascular disease. The number of taken drugs is most eligible as a parameter for patient selection for a Medication Management. Interprofessional collaboration was accepted considerably well by general practitioners. As a final conclusion it can be stated that evidence for the benefits of a collaborative interprofessional Medication Management could be provided for Germany.
References
- 1.
- Hanlon JT, Weinberger M, Samsa GP, Schmader KE, Uttech KM, Lewis IK, Cowper PA, Landsman PB, Cohen HJ, Feussner JR. A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy. Am J Med. 1996 Apr;100(4):428-37. DOI: 10.1016/S0002-9343(97)89519-8
- 2.
- Wittayanukorn S, Westrick SC, Hansen RA, Billor N, Braxton-Lloyd K, Fox BI, Garza KB. Evaluation of medication therapy management services for patients with cardiovascular disease in a self-insured employer health plan. J Manag Care Pharm. 2013 Jun;19(5):385-95. DOI: 10.18553/jmcp.2013.19.5.385
- 3.
- Vinks TH, Egberts TC, de Lange TM, de Koning FH. Pharmacist-based medication review reduces potential drug-related problems in the elderly: the SMOG controlled trial. Drugs Aging. 2009;26(2):123-33. DOI: 10.2165/0002512-200926020-00004
- 4.
- Spinewine A, Swine C, Dhillon S, Lambert P, Nachega JB, Wilmotte L, Tulkens PM. Effect of a collaborative approach on the quality of prescribing for geriatric inpatients: a randomized, controlled trial. J Am Geriatr Soc. 2007 May;55(5):658-65. DOI: 10.1111/j.1532-5415.2007.01132.x
- 5.
- Ramalho de Oliveira D, Brummel AR, Miller DB. Medication therapy management: 10 years of experience in a large integrated health care system. J Manag Care Pharm. 2010 Apr;16(3):185-95. DOI: 10.18553/jmcp.2010.16.3.185
- 6.
- Pauly A, Wolf C, Mayr A, Lenz B, Kornhuber J, Friedland K. Effect of a Multi-Dimensional and Inter-Sectoral Intervention on the Adherence of Psychiatric Patients. PLoS ONE. 2015;10(10):e0139302. DOI: 10.1371/journal.pone.0139302
- 7.
- Obarcanin E, Krüger M, Müller P, Nemitz V, Schwender H, Hasanbegovic S, Kalajdzisalihovic S, Läer S. Pharmaceutical care of adolescents with diabetes mellitus type 1: the DIADEMA study, a randomized controlled trial. Int J Clin Pharm. 2015 Oct;37(5):790-8. DOI: 10.1007/s11096-015-0122-3
- 8.
- Kjeldsen LJ, Bjerrum L, Dam P, Larsen BO, Rossing C, Søndergaard B, Herborg H. Safe and effective use of medicines for patients with type 2 diabetes - A randomized controlled trial of two interventions delivered by local pharmacies. Res Social Adm Pharm. 2015 Jan-Feb;11(1):47-62. DOI: 10.1016/j.sapharm.2014.03.003
- 9.
- Isetts BJ, Schondelmeyer SW, Artz MB, Lenarz LA, Heaton AH, Wadd WB, Brown LM, Cipolle RJ. Clinical and economic outcomes of medication therapy management services: the Minnesota experience. J Am Pharm Assoc. 2008 Mar-Apr;48(2):203-11; 3 p following 211. DOI: 10.1331/JAPhA.2008.07108
- 10.
- Patterson SM, Hughes C, Kerse N, Cardwell CR, Bradley MC. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2012;(5):CD008165. DOI: 10.1002/14651858.CD008165.pub2
- 11.
- Machado M, Bajcar J, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part II: Systematic review and meta-analysis in hypertension management. Ann Pharmacother. 2007 Nov;41(11):1770-81. DOI: 10.1345/aph.1K311
- 12.
- Machado M, Bajcar J, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part I: systematic review and meta-analysis in diabetes management. Ann Pharmacother. 2007 Oct;41(10):1569-82. DOI: 10.1345/aph.1K151
- 13.
- Machado M, Nassor N, Bajcar JM, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part III: systematic review and meta-analysis in hyperlipidemia management. Ann Pharmacother. 2008 Sep;42(9):1195-207. DOI: 10.1345/aph.1K618
- 14.
- Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM, Lewis IK, Cohen HJ, Feussner JR. A method for assessing drug therapy appropriateness. J Clin Epidemiol. 1992 Oct;45(10):1045-51.
- 15.
- Samsa GP, Hanlon JT, Schmader KE, Weinberger M, Clipp EC, Uttech KM, Lewis IK, Landsman PB, Cohen HJ. A summated score for the medication appropriateness index: development and assessment of clinimetric properties including content validity. J Clin Epidemiol. 1994 Aug;47(8):891-6. DOI: 10.1016/0895-4356(94)90192-9
- 16.
- Rose O, Mennemann H, John C, Lautenschläger M, Mertens-Keller D, Richling K, Waltering I, Hamacher S, Felsch M, Herich L, Czarnecki K, Schaffert C, Jaehde U, Köberlein-Neu J. Priority Setting and Influential Factors on Acceptance of Pharmaceutical Recommendations in Collaborative Medication Reviews in an Ambulatory Care Setting - Analysis of a Cluster Randomized Controlled Trial (WestGem-Study). PLoS ONE. 2016;11(6):e0156304. DOI: 10.1371/journal.pone.0156304
- 17.
- Rose O, Schaffert C, Czarnecki K, Mennemann HS, Waltering I, Hamacher S, Felsch M, Herich L, Köberlein J. Effect evaluation of an interprofessional medication therapy management approach for multimorbid patients in primary care: a cluster-randomized controlled trial in community care (WestGem study protocol). BMC Fam Pract. 2015;16:84. DOI: 10.1186/s12875-015-0305-y
