gms | German Medical Science

Background: This study evaluates whether a “patient portfolio” intervention can improve agreement in drug reporting between general practices (GPs) and older patients with multimorbidity. Multimorbidity, defined as two or more chronic diseases and the resulting polypharmacy, prescription of multiple drugs, increase with age. The risk of adverse effects and drug-drug interactions rises sharply with the simultaneous use of five drugs or more. A lack of interprofessional communication and patient-physician communication about medication can lead to discrepancies in GP-reported and patient-reported information on drugs, especially during care transitions. This reporting gap in medication continuity may give rise to deleterious outcomes and inconsistent pharmacotherapy.

Materials and methods: The data were generated within the HYPERION-TransCare substudy 2, a prospective (baseline T0 and follow-up after six months T1), cluster-randomized, multicenter pilot study with two parallel groups. Complete medication data were available on n=67 patients (26 female, 41 male) aged ≥65 years, with multimorbidity, taking five or more chronic drugs, and who had at least one hospitalization in the past year. The intervention group (IG) was provided with a comprehensive “patient portfolio”, encompassing essential patient personal and medical information, along with a patient flyer designed to prepare patients for any medical appointment. The control group (CG), although it did not receive a “patient portfolio”, was also provided with the same patient flyer. Agreement was assessed both for drug name and drug strength, by comparing GP-reported with patient-reported drug information. Group differences and comparison between T0 and T1 were analyzed for the total population and stratified to sex, using Wilcoxon and Mann-Whitney U test (α=5%). Additionally, a sensitivity analysis excluding over-the-counter (OTC) drugs was conducted.

Preliminary results: The IG showed a small non-significant decrease in agreement at six-month follow up (T0=71.4%, T1=66.7% p=.181), whereas the agreement of CG increased non-significantly (T0=73.9%, T1=75.0% p=.658). For men, there was a decrease in agreement at T1, which was statistically significant in the IG (IG: -13.3%, p=.017; CG: -5.6%, p=.835). In contrast, for women, there was a small non-significant increase in both groups (IG: +3.4% p=.767; CG: +9.9%, p=.600). Both at T0 and T1, median agreement on drug name reporting (T0=70.56%, T1=66.45%) was significantly higher (p<.001) than agreement on drug reporting including drug strength (T0=61.04%, T1=58.90%). Final results and outcomes of the sensitivity analysis excluding OTC drugs will be presented at the conference.

Preliminary conclusion: The results show the expected discrepancy between GP-reported and patient-reported drug. We found a clear gender-related disparity in drug agreement. In an upcoming main study, we aim to validate these outcomes within a larger patient population.