gms | German Medical Science

Background: In the interprofessional medication management programme ARMIN almost 10,000 patients with polymedication were jointly cared for by community pharmacists and primary care physicians. Results of the external evaluation, utilizing secondary health care (claims) data, demonstrated a significant reduction in mortality (relative risk reduction of 16%) [1].

To gain a deeper understanding of the interventions carried out and on the interaction between the health care professionals, we aimed to evaluate drug-related problems (DRPs) and the resulting pharmaceutical interventions (PI).

Materials and methods: We conducted an intervention study with a pre-post design in the ambulatory setting with an observational period of approximately six months per patient. The intervention i.e., participation in ARMIN, consisted of an initial type 3 medication review (according to the Pharmaceutical Care Network Europe (PCNE) nomenclature [2], i.e., a structured evaluation and optimization of a patient’s medication including the medication history, patient interview, and clinical data) and follow up-interventions during every visit at the pharmacy or physicians’ practice.

We aimed to recruit a convenience sample of n=60 patients to assess: (i) number and types of DPRs, (ii) PIs conduced, (iii) clinical and economic impact of the PIs, and (iv) involvement of physicians.

DRPs were classified by the PharmDISC system (Pharmacists’ Documentation of Interventions in Seamless Care) [3]. The clinical and economic relevance of all successfully implemented PIs was estimated with the German version of the CLEOde tool [4].

Results: 79 patients (54% female, 62.3% >65 years) taking a median of 9 different drugs (range 5–26) were recruited by 17 community pharmacies.

(i) 470 DRPs were detected in 92% of the patients. The median number of DPRs per patient was 6 (range 0–19). Nearly 90% (n=420) of the DRPs were detected during the initial medication review whereas 11% were documented during the continuous medication management. Most often, DRPs related to dosage (n=130; 27.7%), drug-drug interaction (DDI; n=104; 22.1%), and indication (n=80; 17.0%).

(ii) Altogether, 538 PIs were conduced since 68 DRPs resulted in more than one PI. The interventions accounting for almost 80% of all PIs were “in-depth counselling of patient” (n=188), “optimisation of administration/route” (n=106) and “transmission of information” (n=100).

(iii) Assessing the impact was possible for all PIs classified as successfully implemented (n=404; 76.0%). Overall, 394 (97.5%) of these PIs had a positive clinical impact. 18.1% (n=73) of the PIs had an economic impact: 50 (12.4%) PIs resulting in an increase and 23 (5.7%) in a reduction of drug and monitoring costs.

(iv) In 42.2% (n=227) of PIs, the prescribing physician was contacted, most often (approximately 60%) because of the following DRPs: DDIs (n=67), followed by “non-adherence” (n=37) and “side effects” (n=32). In almost half of the contacts (n=100) the physician received information (“transmission of information”); only in 23.6% (n=127) of all Pis, physicians had to make decisions or act.

Conclusion: In most patients within the medication management programme ARMIN several DRPs were identified and solved, with the vast majority deemed clinically relevant. Most DPRs were solved solely by the pharmacist with less than 25% of all PIs requiring an active contribution from the physician. This indicates that pharmacists contributed considerably to optimize the patients’ medication.