gms | German Medical Science

14. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie

Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie

15.11. - 16.11.2007, Frankfurt am Main

Improving medication safety for patients with chronic renal impairment in general practice

Meeting Abstract

  • corresponding author J. Petersen - Institut for General Practice, Johann Wolfgang Goethe-University, Frankfurt / Main
  • M. Beyer - Institut for General Practice, Johann Wolfgang Goethe-University, Frankfurt / Main
  • A. Erler - Institut for General Practice, Johann Wolfgang Goethe-University, Frankfurt / Main
  • T. Rath - Institut for General Practice, Johann Wolfgang Goethe-University, Frankfurt / Main
  • K. Saal - Institut for General Practice, Johann Wolfgang Goethe-University, Frankfurt / Main
  • F. M. Gerlach - Institut for General Practice, Johann Wolfgang Goethe-University, Frankfurt / Main

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 14. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Frankfurt am Main, 15.-16.11.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. Doc07gaa12

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/gaa2007/07gaa12.shtml

Published: November 12, 2007

© 2007 Petersen et al.
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Outline

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Context: Chronic renal impairment is a frequent condition in primary care patients, because old age as well as common diagnoses (hypertension, diabetes) are major risk factors. However, identification of these patients and calculation of their correct medication dosages can be complicated and time-consuming for GPs in daily practice, which may result in inappropriate and potentially harmful prescribing.

Objectives: To examine whether medication safety for patients with chronic renal impairment can be improved by an intervention consisting of a training session on renal impairment, the use of a CD-based software tool allowing easy calculation of renal function and providing guidance on dosage reduction, a “desktop-checklist” of medications requiring dosage reduction and information leaflets on renal impairment for patients.

Design, setting and participants: Cluster-randomised controlled trial (RCT) in 46 general practices, randomly allocated to intervention or control group (usual care). From all patients with a diagnosis of renal impairment (group 1) respectively hypertension plus age >69 years (group 2) and a creatinine clearance <50 ml/min (Cockroft-Gault formula), we randomly selected 5 study patients per group and practice. We reviewed the patient’s medication; this will be repeated after 6 months.

Main outcome measures: Prevalence of prescriptions containing an inappropriate dosage before and after intervention compared with control group

Preliminary results of participants: 44 GP practices participated in the study (2 failed to provide data). 9/21 were group practices (control group 8/23), 11/21 of the GPs in the intervention group were male (control group 17/23). On average, GPs owned their practices for 14,1 (control group 13,5) ys. 405 patients were included (8-12/practice), 207 in group 1, 198 in group 2. Mean age in group 1 was 79,4; in group 2 81,5 ys. We will present a summary of the baseline data (e.g. number of prescriptions with inappropriate dosage, contraindicated medications).

Conclusions: Providing a software tool for easy calculation of renal function and correct medication dosage might help GPs in reducing the number of inappropriate prescriptions in patients with renal impairment.