gms | German Medical Science

29th Annual Meeting of the German Drug Utilisation Research Group (GAA)

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie

24.11. - 25.11.2022, Münster

Relevance of complexity factors that cannot be derived from medication schedules

Meeting Abstract

  • corresponding author presenting/speaker Steffen J. Schmidt - Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
  • Viktoria S. Wurmbach - Department of Clinical Pharmacology and Pharmacoepidemiology, Cooperation Unit Clinical Pharmacy, Heidelberg University Hospital, Heidelberg, Germany
  • Anette Lampert - Department of Clinical Pharmacology and Pharmacoepidemiology, Cooperation Unit Clinical Pharmacy, Heidelberg University Hospital, Heidelberg, Germany
  • Simone Bernard - Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
  • Andreas D. Meid - Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
  • Eduard Frick - Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
  • Michael Metzner - Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
  • Stefan Wilm - Institute of General Practice (Ifam), Centre for Health and Society (Chs), Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
  • Achim Mortsiefer - Institute of General Practice (Ifam), Centre for Health and Society (Chs), Medical Faculty, Heinrich Heine University Düsseldorf; Professorship of Primary Care, Faculty of Health, Witten/Herdecke University, Witten, Germany
  • Bettina Bücker - Institute of General Practice (Ifam), Centre for Health and Society (Chs), Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
  • Attila Altiner - Institute of General Practice, Rostock University Medical Center, Rostock, Germany
  • Lisa Sparenberg - Institute of General Practice, Rostock University Medical Center, Rostock, Germany
  • Joachim Szecsenyi - Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
  • Frank Peters-Klimm - Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
  • Petra Kaufmann-Kolle - AQUA-Institute for Applied Quality Improvement and Research in Health Care, Göttingen, Germany
  • Walter E. Haefeli - Department of Clinical Pharmacology and Pharmacoepidemiology, Cooperation Unit Clinical Pharmacy, Heidelberg University Hospital, Heidelberg, Germany
  • Hanna M. Seidling - Department of Clinical Pharmacology and Pharmacoepidemiology, Cooperation Unit Clinical Pharmacy, Heidelberg University Hospital, Heidelberg, Germany
  • Petra A. Thürmann - Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany; Philipp Klee-Institute for Clinical Pharmacology, HELIOS Clinic Wuppertal, Wuppertal, Germany

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 29. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Münster, 24.-25.11.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. Doc22gaa12

doi: 10.3205/22gaa12, urn:nbn:de:0183-22gaa124

Published: November 21, 2022

© 2022 Schmidt et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Background: In the HIOPP-6 pilot study, drug treatment of adult patients in primary care was analyzed regarding different factors contributing to the complexity of their pharmacotherapy. Some complexity factors, such as tablet splitting, use of inhalers etc., can be derived electronically from the “Bundeseinheitlicher Medikationsplan” (a standardized medication schedule), while other factors, such as swallowing difficulties, can only be reported by patients themselves [1]. As part of the HIOPP-6 study protocol, such individual patient-specific factors were addressed by general practitioners using predefined questions [2], [3].

Materials and Methods: Forty-eight patients answered eight questions each to identify 14 complexity factors that cannot be derived from the medication schedule. The questions were phrased as closed questions and were basically intended to indicate a problem by confirmation, e.g. ‘Do you have problems swallowing your drugs?’ for the complexity factor ‘swallowing difficulties’ or ‘Do you have problems distinguishing your drugs because they look similar or their names sound alike?’ for the complexity factor ‘similar drug appearance’.

Results: In total, the questions revealed complexity factors for nearly three out of four patients (72.9 %). Fifty percent of patients reported not using their medication schedule, although 29.2 % had difficulties remembering drug names or dosage schemes. One in eight patients reported difficulties handling drug packaging and/or physical impairments that affect drug administration. About one in ten patients (10.4 %) reported difficulties with similar drug appearances or with changes in prescriptions or generic substitutions. Only two patients (4.2 %) reported swallowing difficulties, none reported problems due to diverse storage conditions of their drugs.

Conclusion: There are highly relevant factors for the complexity of drug treatment that can only be detected by interviewing patients [3]. Therefore, an analysis of the complexity of drug treatment should not be based on medication schedule alone but should also include the patient’s perspective on factors that cannot be derived from the medication schedule.


References

1.
Wurmbach VS, Schmidt SJ, Lampert A, Frick E, Metzner M, Bernard S, Thürmann PA, Wilm S, Mortsiefer A, Altiner A, Sparenberg L, Szecsenyi J, Peters-Klimm F, Kaufmann-Kolle P, Haefeli WE, Seidling HM. Development of an algorithm to detect and reduce complexity of drug treatment and its technical realisation. BMC Med Inform Decis Mak. 2020;20:154. DOI: 10.1186/s12911-020-01162-6 External link
2.
Wurmbach VS, Schmidt SJ, Lampert A, Bernard S, Faller CK, Thürmann PA, Haefeli WE, Seidling HM, HIOPP-6 Consortium. Development and Pilot-Testing of Key Questions to Identify Patients' Difficulties in Medication Administration. Patient Prefer Adherence. 2021;15:2479-2488. DOI: 10.2147/PPA.S328380 External link
3.
Wurmbach VS, Schmidt SJ, Lampert A, Bernard S, Meid A, Frick E, Metzner M, Wilm S, Mortsiefer A, Bücker B, Altiner A, Sparenberg L, Szecsenyi J, Peters-Klimm F, Kaufmann-Kolle P, Thürmann PA, Haefeli WE, Seidling HM. Prevalence and patient-rated relevance of complexity factors in medication regimens of community-dwelling patients with polypharmacy. Eur J Clin Pharmacol. 2022;78:1127-1136. DOI: 10.1007/s00228-022-03314-1 External link