gms | German Medical Science

Background: From October 2016 on, patients in Germany can claim a Medication Plan by their physician, displaying the name of the drug, the dose and the purpose of use. The Medication Plan should be issued by any physician on patient request. Any other physician or pharmacist is required to update the plan on patient demand. Structured Medication Reconciliation or Medication Review is not a part of the Medication Plan but would offer the opportunity to detect drug related problems (DRPs) [1]. A cooperation of physicians and pharmacists has shown to be beneficial for Medication Reconciliation in a study by Geurts et al. [2]. A Brown-Bag Review is an established part of Medication Reconciliation in many countries and diverse settings [3], [4], [5], [6]. For Germany the data on Medication Plan, Medication Reconciliation and Brown-Bag Review is scarce. A first study by Waltering et al. revealed that as little as 6.5% of German patients in a Medication Review had comprehensive Medication Plans [7]. The aims of this study were to analyze discrepancies between the available data on medication of the general practitioner (GP) and the medication found at a Home Medicines Review, to list the drugs that were not documented and to estimate the relevance of the omitting data on patient care. Findings might lead to a more evidence based approach in coordinating interprofessional collaboration in Medication Reconciliation.

Materials and Methods: Medication Reconciliation leads to disclosure of otherwise undocumented or unknown medication of the patient to all health-care providers [6]. In this elaboration, the patient was assessed two times and a brown-bag review was performed. Drugs that were found at home but were not documented by the general practitioner were listed. To get a deeper impression on the relevance of the omitting drugs, they were tried to be categorized under risk and indication aspects. In a first step it was rated whether the omitting drugs were believed to be relevant to the general practitioner or of little important. Relevance was given if drugs needed clinical monitoring or caused considerable systemic effects (most prescription drugs). Drugs were categorized less relevant if they had a limited systemic effect or seemed to be used only in acute situations (i.e. eye drops, topic- or cold-relief medication). Sedative drugs were identified using pharmaceutical expertise and by the PRISCUS list [8]. Drugs were classified as carrying a high risk for hospitalization according to studies by van der Hooft et al. and Budnitz et al. [9], [10] and resembled of anticoagulation drugs, digoxin, cytostatics, diuretics, insulines, oral antidiabetics with risk of hypoglycemia, salicylates or disease-modifying antirheumatic drugs (DMARDs). High-cost drugs were defined as a price of >1200 € per package. All not documented drugs were clustered for cardiovascular, pain related, psychoactive, gastrointestinal or pneumologic medication (indication clusters), if eligible. The data for this assessment was obtained from the documentation of the general practitioner and the documentation of home-care specialists at an assessment at the patient’s home. Research on Medication Reconciliation was qualitative and descriptive. Cases of not documented drugs were counted, percentages were calculated.

Results: Full documentation of the medication of the general practitioner and comprehensive assessments of the home-care specialists was obtained for 142 patients. Preliminary results show a total of 1749 discrepancies, which were analyzed by study pharmacists and reported to the general practitioner during two subsequent Medication Reviews. 179 different drugs were detected. 125 of these drugs were rated as relevant for the therapeutic regimen as they were prescription drugs or led to significant systemic effects. 15 drugs had sedating effects and might increase fall risk, 12 were listed in the PRISCUS list of potential inappropriate medication for elderly patients and 33 of the 179 drugs could be associated to a high risk for hospitalization. 99 drugs could be classified as having a considerable potential for drug-drug interactions. With Adalimumab, Etanercept and Imatinib, three drugs belonged to the high-cost group (>1200 €). To get a more defined impression, the 179 drugs were related to 5 clusters of indication. As a result, 58 cardiovascular drugs, 45 pain relievers, 48 psychoactive drugs, 57 gastrointestinal drugs and 42 respiratory drugs were found. All results are preliminary and need to be approved by further analyses.

Conclusion: In multimorbid patients with polymedication, a high number of drugs was found, which was not documented by the general practitioner. The majority of these drugs were prescription drugs or led to significant systemic effects. Many of these drugs carried a high risk for hospitalization. The high relevance of the taken, but not documented medication indicates that prescriptions of other physicians and over-the-counter drugs are frequently not reported to the general practitioner.

Interprofessional cooperation of home-care specialists, pharmacists and physicians could reveal discrepancies, add the drugs to the general practitioner’s documentation and hence increase the quality of therapy and reduce medication risk.