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Vogel JB, Neyer M, Elsner P, Vonbank A, Plattner T, Saely CH, Leiherer A, Drexel H. Current Practices of Medication Plans in Austrian Patients Undergoing Coronary Angiography: An In-Depth Analysis. J Clin Med 2024; 13:3187. [PMID: 38892897 PMCID: PMC11172892 DOI: 10.3390/jcm13113187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/19/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
A complete medication plan (MPlan) increases medication safety and adherence and is crucial in care transitions. Countries that implemented a standardized MPlan reported benefits on patients' understanding and handling of their medication. Austria lacks such a standardization, with no available data on the issue. Objective: This study aimed to investigate the current state of all medication documentations (MDocs) at hospital admission in a population at high risk for polypharmacy in Austria. Methods: We enrolled 512 consecutive patients undergoing elective coronary angiography. Their MDocs and medications were recorded at admission. MDocs were categorized, whereby a MPlan was defined as a tabular list including medication name, dose, route, frequency and patient name. Results: Out of 485 patients, 55.1% had an MDoc (median number of drugs: 6, range 2-17), of whom 24.7% had unstructured documentation, 18.0% physicians' letters and 54.3% MPlans. Polypharmacy patients did not have a MDoc in 31.3%. Crucial information as the patients's name or the originator of the MDoc was missing in 31.1% and 20.4%, respectively. Patients with MDoc provided more comprehensive medication information (p = 0.019), although over-the-counter-medication was missing in 94.5% of MDocs. A discrepancy between the MPlan and current medication at admission existed in 64.4%. In total, only 10.7% of our patient cohort presented an MPlan that was in accordance with their current medication. Conclusion: The situation in Austria is far from a standardized MPlan generated in daily routine. Numerous MPlans do not represent the current medication and could pose a potential risk for the effectiveness and safety of pharmacotherapy.
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Affiliation(s)
- Johannes B. Vogel
- Faculty of Medical Sciences, Private University in the Principality of Liechtenstein (UFL), 9495 Triesen, Liechtenstein (A.L.)
- Vorarlberg Institute for Vascular Investigation & Treatment (VIVIT), 6800 Feldkirch, Austria
| | - Magdalena Neyer
- Faculty of Medical Sciences, Private University in the Principality of Liechtenstein (UFL), 9495 Triesen, Liechtenstein (A.L.)
- Vorarlberg Institute for Vascular Investigation & Treatment (VIVIT), 6800 Feldkirch, Austria
| | - Pascal Elsner
- Faculty of Medical Sciences, Private University in the Principality of Liechtenstein (UFL), 9495 Triesen, Liechtenstein (A.L.)
- Vorarlberg Institute for Vascular Investigation & Treatment (VIVIT), 6800 Feldkirch, Austria
| | - Alexander Vonbank
- Faculty of Medical Sciences, Private University in the Principality of Liechtenstein (UFL), 9495 Triesen, Liechtenstein (A.L.)
- Vorarlberg Institute for Vascular Investigation & Treatment (VIVIT), 6800 Feldkirch, Austria
- Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria
| | - Thomas Plattner
- Faculty of Medical Sciences, Private University in the Principality of Liechtenstein (UFL), 9495 Triesen, Liechtenstein (A.L.)
- Vorarlberg Institute for Vascular Investigation & Treatment (VIVIT), 6800 Feldkirch, Austria
- Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria
| | - Christoph H. Saely
- Faculty of Medical Sciences, Private University in the Principality of Liechtenstein (UFL), 9495 Triesen, Liechtenstein (A.L.)
- Vorarlberg Institute for Vascular Investigation & Treatment (VIVIT), 6800 Feldkirch, Austria
- Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria
| | - Andreas Leiherer
- Faculty of Medical Sciences, Private University in the Principality of Liechtenstein (UFL), 9495 Triesen, Liechtenstein (A.L.)
- Vorarlberg Institute for Vascular Investigation & Treatment (VIVIT), 6800 Feldkirch, Austria
- Medical Central Laboratories, 6800 Feldkirch, Austria
| | - Heinz Drexel
- Faculty of Medical Sciences, Private University in the Principality of Liechtenstein (UFL), 9495 Triesen, Liechtenstein (A.L.)
- Vorarlberg Institute for Vascular Investigation & Treatment (VIVIT), 6800 Feldkirch, Austria
- Medical Central Laboratories, 6800 Feldkirch, Austria
- Landeskrankenhaus-Betriebsgesellschaft, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria
- Drexel University College of Medicine, Philadelphia, PA 19129, USA
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Strumann C, Pfau L, Wahle L, Schreiber R, Steinhäuser J. Designing and Implementation of a Digitalized Intersectoral Discharge Management System and Its Effect on Readmissions: Mixed Methods Approach. J Med Internet Res 2024; 26:e47133. [PMID: 38530343 PMCID: PMC11005442 DOI: 10.2196/47133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/13/2023] [Accepted: 01/31/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Digital transformation offers new opportunities to improve the exchange of information between different health care providers, including inpatient, outpatient and care facilities. As information is especially at risk of being lost when a patient is discharged from a hospital, digital transformation offers great opportunities to improve intersectoral discharge management. However, most strategies for improvement have focused on structures within the hospital. OBJECTIVE This study aims to evaluate the implementation of a digitalized discharge management system, the project "Optimizing instersectoral discharge management" (SEKMA, derived from the German Sektorübergreifende Optimierung des Entlassmanagements), and its impact on the readmission rate. METHODS A mixed methods design was used to evaluate the implementation of a digitalized discharge management system and its impact on the readmission rate. After the implementation, the congruence between the planned (logic model) and the actual intervention was evaluated using a fidelity analysis. Finally, bivariate and multivariate analyses were used to evaluate the effectiveness of the implementation on the readmission rate. For this purpose, a difference-in-difference approach was adopted based on routine data of hospital admissions between April 2019 and August 2019 and between April 2022 and August 2022. The department of vascular surgery served as the intervention group, in which the optimized discharge management was implemented in April 2022. The departments of internal medicine and cardiology formed the control group. RESULTS Overall, 26 interviews were conducted, and we explored 21 determinants, which can be categorized into 3 groups: "optimization potential," "barriers," and "enablers." On the basis of these results, 19 strategies were developed to address the determinants, including a lack of networking among health care providers, digital information transmission, and user-unfriendliness. On the basis of these strategies, which were prioritized by 11 hospital physicians, a logic model was formulated. Of the 19 strategies, 7 (37%; eg, electronic discharge letter, providing mobile devices to the hospital's social service, and generating individual medication plans in the format of the national medication plan) have been implemented in SEKMA. A survey on the fidelity of the application of the implemented strategies showed that 3 of these strategies were not yet widely applied. No significant effect of SEKMA on readmissions was observed in the routine data of 14,854 hospital admissions (P=.20). CONCLUSIONS This study demonstrates the potential of optimizing intersectoral collaboration for patient care. Although a significant effect of SEKMA on readmissions has not yet been observed, creating a digital ecosystem that connects different health care providers seems to be a promising approach to ensure secure and fast networking of the sectors. The described intersectoral optimization of discharge management provides a structured template for the implementation of a similar local digital care networking infrastructure in other care regions in Germany and other countries with a similarly fragmented health care system.
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Affiliation(s)
- Christoph Strumann
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Lisa Pfau
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Laila Wahle
- Lacanja GmbH Health Innovation Port, Hamburg, Germany
| | - Raphael Schreiber
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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Hellinger BJ, Remane Y, Bertsche T, Gries A. [Adverse drug reactions as cause of nonspecific symptoms in patients in the emergency department]. DIE ANAESTHESIOLOGIE 2023; 72:887-893. [PMID: 37978070 DOI: 10.1007/s00101-023-01355-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND In a large proportion of patients admitted to the emergency department (ED), the initial main symptom is nonspecific. One possible reason for this, especially in older patients, may be adverse drug reactions (ADR) due to their frequent polypharmacy. AIM To illustrate the incidence of ADRs, the affected patient population including risk factors, and drug classes with ADRs leading to nonspecific symptoms. To provide practice recommendations for the management of ADRs in the ED. MATERIAL AND METHODS Presentation of the pharmacological principles on ADRs, statistics of pharmacovigilance centers as well as original literature including experiences from clinical practice and own projects. RESULTS In 10% of patients with nonspecific symptoms an ADR is responsible for presentation in the ED. In 60% of cases these ADRs are not correctly identified in the ED setting. A small number of drug classes are responsible for most of these referrals. Databases, risk stratification, clinical pharmacists, or clinical decision support systems are available to improve ADR identification and management. As these options are partly associated with considerable costs or the validation for German EDs is missing, a widespread application does not take place. CONCLUSION Correct identification of ADRs in patients with nonspecific symptoms in the ED is necessary to initiate adequate treatment. These ADRs are often overlooked because processes and tools for identification and management are not applied in the ED, leading to a lack of awareness. For high-risk patients in the ED, the focus should be on drug history, ideally considering patient-specific risk factors and specific drug classes.
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Affiliation(s)
- Benjamin J Hellinger
- Klinikapotheke, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland.
- Abteilung für Klinische Pharmazie, Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland.
- Zentrale Notaufnahme/Beobachtungsstation, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - Yvonne Remane
- Klinikapotheke, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| | - Thilo Bertsche
- Abteilung für Klinische Pharmazie, Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland
| | - André Gries
- Zentrale Notaufnahme/Beobachtungsstation, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland
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Eickhoff C, Müller U, Thomas S, Schmidt C, Hartling LS, Michael S, Schulz M, Bertsche T. Patients' Use of a Standardized Medication List - A Mixed Methods Study. Patient Prefer Adherence 2023; 17:2655-2666. [PMID: 37927342 PMCID: PMC10624198 DOI: 10.2147/ppa.s427192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/19/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose A medication list (ML) is a document listing the patient's entire medication, instructions for use, and indications. In Germany, a national standard was established in 2016 by law. However, data on patients' use of this standardized ML are scarce. We investigated (i) patients' practical use of the ML, (ii) patients' understanding of the ML, (iii) completeness and correctness of the current ML version, and (iv) reasons why patients did not adhere to their ML. Patients and Methods Community pharmacists recruited patients possessing a standardized ML with ≥5 medications. Information sources to evaluate the ML were: (a) brown bag analysis, (b) practical demonstration, (c) patient interview, and (d) patient file. Data were analyzed using qualitative and quantitative methods. Results Two hundred and eighty-eight patients (median age: 76 years, range: 27-95) were enrolled. (i) 38.5% of the patients used their ML regularly to prepare their medication and 73.3% to inform their physician. (ii) Overall, patients' understanding of the ML was good, with >80% of the patients being able to identify all relevant information. (iii) While n = 2779 medications were actually taken, n = 2539 were documented on the ML. No ML was fully correct and complete. Regarding particularly relevant items, ie, active ingredient, strength, dosage, medication missing or listed but not taken, 79.2% of ML were incorrect or incomplete. Handwritten modifications on the ML were frequent. (iv) Almost 60% of all patients did not follow their ML with "fear of adverse drug reactions" being the most frequently (n = 50) mentioned reason. Conclusion Completeness and correctness of the current ML version was poor with handwritten modifications being frequent. Additionally, most of the patients did not adhere to their ML. This indicates that measures that lead to correct and up-to-date ML and improvements in patient counseling about their medication should be developed and implemented into routine practice.
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Affiliation(s)
- Christiane Eickhoff
- Department of Medicine, ABDA – Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Uta Müller
- Department of Medicine, ABDA – Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Sophie Thomas
- Clinical Pharmacy Department, Institute of Pharmacy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Christian Schmidt
- Clinical Pharmacy Department, Institute of Pharmacy, Medical Faculty, Leipzig University, Leipzig, Germany
| | | | - Sebastian Michael
- Löwen-Apotheke Waldheim e.K, Waldheim, Germany
- Saxon Pharmacists Association, Leipzig, Germany
| | - Martin Schulz
- Department of Medicine, ABDA – Federal Union of German Associations of Pharmacists, Berlin, Germany
- Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
| | - Thilo Bertsche
- Clinical Pharmacy Department, Institute of Pharmacy, Medical Faculty, Leipzig University, Leipzig, Germany
- Drug Safety Center, Medical Faculty, Leipzig University and Leipzig University Hospital, Leipzig, Germany
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[Digitalization in healthcare: today and in the future]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:105-113. [PMID: 36648499 DOI: 10.1007/s00103-022-03642-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/12/2022] [Indexed: 01/18/2023]
Abstract
Although Germany continues to struggle with the digital transformation of healthcare, there is reason for optimism. The political will to improve healthcare with digital technologies has been underpinned by numerous legal initiatives since 2018. In addition, there is growing acceptance among healthcare providers and the population. The latter has clearly been driven by the corona pandemic, which underscored the need for more digitized care.Digitalization in healthcare has three key drivers: the rapid technological development in data processing, the ever-improving understanding of the biological basis of human life, and growing patient sovereignty coupled with a growing desire for transparency. Prerequisites for digital medicine are data interoperability and the establishment of a networking (telematics) infrastructure (TI). The status of the most important digital TI applications affecting German healthcare are described: the electronic patient record (ePA) as its core as well as electronic prescriptions, medication plans, and communication tools such as Communication in Medicine (KIM) and TI Messenger (TIM). In addition, various telemedical offerings are discussed as well as the introduction of digital health applications (DiGA) into the statutory healthcare system, which Germany has pioneered. Furthermore, the use of medical data as the basis for artificial intelligence (AI) algorithms is discussed. While helpful and capable of improving diagnostics as well as medical therapy, such AI tools will not replace doctors and nurses.
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6
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Extended Pharmacist Assessment of Medication Safety for Nursing Home Residents—A Cross-Sectional and Prospective Study. J Clin Med 2022; 11:jcm11216602. [DOI: 10.3390/jcm11216602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
In the routine pharmacist’s medication review in ambulatory care and nursing homes in Germany, clinical diagnoses are often insufficiently considered as they are frequently not accessible to pharmacists and their electronic support tools. This may leave a significant proportion of medication-related problems (MRP) undetected and unresolved. Moreover, limited and incomplete data may promote spurious alerts of low clinical relevance. In order to assess the impact of improved data availability, we conducted a study (German Clinical Trials Register DRKS00025346) to evaluate the impact of an extended pharmacist’s medication review, made possible by diagnosis data being routinely available to the pharmacist. At six nursing homes in the Nuremberg metropolitan area, 338 patients treated by 32 physicians were enrolled. A pharmacist’s medication review, considering only the medication data, identified 114 potential MRPs, and additional consideration of diagnoses further identified 69 potential MRPs. The physicians adapted the therapy in response to 69.9% of alerts. The observed gain in MRP identified indicates that efforts should be intensified to facilitate and improve consideration of drug–diagnosis-related MRP by improving data sharing and communication between pharmacists and physicians caring for nursing home residents.
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Wakob I, Schmid GL, Nöhring I, Elze R, Sultzer R, Frese T, Schiek S, Bertsche T. Developing a Mobile Health Application to Communicate Adverse Drug Reactions - Preconditions, Assessment of Possible Functionalities and Barriers for Patients and Their General Practitioners. J Multidiscip Healthc 2022; 15:1445-1455. [PMID: 35837350 PMCID: PMC9275429 DOI: 10.2147/jmdh.s369625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/17/2022] [Indexed: 01/04/2023] Open
Abstract
Purpose Mobile health (mHealth) applications offer structured and timely communication between patients and general practitioners (GPs) about adverse drug reactions (ADR). Preconditions, functionalities and barriers should be studied to ensure safe implementation. Methods We performed a cross-sectional questionnaire survey addressing (i) preconditions, (ii) users’ assessment of functionalities and (iii) barriers to mHealth managing ADR communication. Results A total of 480 patients and 31 GPs completed the survey. (i) A total of 269 (56%) patients and 13 (42%) GPs were willing to use mHealth for ADR communication. Willingness was negatively correlated with age for both patients (r = −0.231; p < 0.001) and GPs (r = −0.558; p = 0.002). (ii) Most useful functionalities mentioned by patients (>60%) included “Rapid feedback on urgency of face-to-face consultations.” GPs valued information on “Patient’s difficulties in medication administration.” (iii) In free-text answers, the barrier reported most frequently by patients was “preferred personal GP contact” (6%), whereas GPs claimed, “uncomplicated use with low expenditure of time and personnel” (19%). Conclusion Older patients and GPs mainly show reservations about mHealth for ADR communication but recognize possible benefits. mHealth implementation should avoid a negative effect on GPs’ time budgets; the primary goal should not be to reduce the number of GP-patient contacts but to optimize them.
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Affiliation(s)
- Ines Wakob
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Leipzig, Germany.,Drug Safety Center, Faculty of Medicine, University Hospital of Leipzig and Leipzig University, Leipzig, Germany
| | - Gordian Lukas Schmid
- Department of General Practice, Medical Faculty of the University of Leipzig, Leipzig, Germany
| | - Ingo Nöhring
- Department of General Practice, Medical Faculty of the University of Leipzig, Leipzig, Germany
| | - Romy Elze
- University Computer Center, Department of Research and Development, Leipzig University, Leipzig, Germany
| | | | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University, Halle (Saale), Germany
| | - Susanne Schiek
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Leipzig, Germany.,Drug Safety Center, Faculty of Medicine, University Hospital of Leipzig and Leipzig University, Leipzig, Germany
| | - Thilo Bertsche
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Leipzig, Germany.,Drug Safety Center, Faculty of Medicine, University Hospital of Leipzig and Leipzig University, Leipzig, Germany
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[Medication management in home care-The medication use process from the perspective of clients and their caregivers]. Z Gerontol Geriatr 2022; 55:667-672. [PMID: 34694446 PMCID: PMC9726664 DOI: 10.1007/s00391-021-01985-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/29/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Professional home care nurses are often tasked with the medication management of older, polymedicated clients. The medication use process is often complex and prone to medication errors. From the perspective of professional caregivers, the interprofessional interfaces of care as well as the integration of clients and informal caregivers are a major challenge. AIM With this study, we explored the perspective of home care clients and their informal caregivers on the medication use process supported by professional caregivers with a focus on medication safety. METHOD We chose a qualitative research approach, using guideline-based interviews with eight clients and five caregivers. Data were analyzed applying the topical analysis according to Braun and Clarke. RESULTS AND DISCUSSION Before engaging professional home care nurses in the medication use process, clients reached their physical, psychological and social limits. They were relieved when the professional home care organization took care of the overall coordination of the medication use process and felt safe. They trust professional caregivers and see limited need to be preoccupied with medication safety themselves, despite risks inherent in self-medication, adherence and transition of care. CONCLUSION Through the relief provided by professional caregivers, home care clients and their informal caregivers no longer perceive themselves as active partners in maintaining medication safety. Healthcare professionals should keep an eye on self-medication as well as adherence and support the use of the medication plan.
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Man vs. machine: comparison of pharmacogenetic expert counselling with a clinical medication support system in a study with 200 genotyped patients. Eur J Clin Pharmacol 2021; 78:579-587. [PMID: 34958399 PMCID: PMC8926977 DOI: 10.1007/s00228-021-03254-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022]
Abstract
Background Medication problems such as strong side effects or inefficacy occur frequently. At our university hospital, a consultation group of specialists takes care of patients suffering from medication problems. Nevertheless, the counselling of poly-treated patients is complex, as it requires the consideration of a large network of interactions between drugs and their targets, their metabolizing enzymes, and their transporters, etc. Purpose This study aims to check whether a score-based decision-support system (1) reduces the time and effort and (2) suggests solutions at the same quality level. Patients and methods A total of 200 multimorbid, poly-treated patients with medication problems were included. All patients were considered twice: manually, as clinically established, and using the Drug-PIN decision-support system. Besides diagnoses, lab data (kidney, liver), phenotype (age, gender, BMI, habits), and genotype (genetic variants with actionable clinical evidence I or IIa) were considered, to eliminate potentially inappropriate medications and to select individually favourable drugs from existing medication classes. The algorithm is connected to automatically updated knowledge resources to provide reproducible up-to-date decision support. Results The average turnaround time for manual poly-therapy counselling per patient ranges from 3 to 6 working hours, while it can be reduced to ten minutes using Drug-PIN. At the same time, the results of the novel computerized approach coincide with the manual approach at a level of > 90%. The holistic medication score can be used to find favourable drugs within a class of drugs and also to judge the severity of medication problems, to identify critical cases early and automatically. Conclusion With the computerized version of this approach, it became possible to score all combinations of all alternative drugs from each class of drugs administered (“personalized medication landscape “) and to identify critical patients even before problems are reported (“medication alert”). Careful comparison of manual and score-based results shows that the incomplete manual consideration of genetic specialties and pharmacokinetic conflicts is responsible for most of the (minor) deviations between the two approaches. The meaning of the reduction of working time for experts by about 2 orders of magnitude should not be underestimated, as it enables practical application of personalized medicine in clinical routine.
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Unerwünschte Arzneimittelwirkungen und Medikationsfehler – was Akut- und Notfallmediziner wissen sollten. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00896-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rose O, Happe S, Huchtemann T, Mönig C, Ohms M, Schwalbe O, Warnecke T, Erzkamp S. Enhancing medication therapy in Parkinson's disease by establishing an interprofessional network including pharmacists. Int J Clin Pharm 2021; 43:441-448. [PMID: 33893597 DOI: 10.1007/s11096-021-01263-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/26/2021] [Indexed: 01/28/2023]
Abstract
Background Optimizing therapy regimens through collaboration and combination of available resources is a promising approach to improve quality of life for patients with Parkinson's disease (PD). Aim The aim of this project was to enhance patient-oriented therapy and interprofessional collaboration by establishing a regional PD network. Setting The network is located in a rural area in Germany. It covers primary, secondary and tertiary care facilities across professional boundaries. Development Recruitment of PD specialists and patient support groups was done by the local newspaper to spread the word. The network was initially open to all healthcare professionals, who stated a focus or special interest in PD. A working group for medication was founded within the network by asking for interested participants. Problems in the medication process were discussed within the group. As a consequence, therapy recommendations (quickcards) and a specific medication plan were developed and a certified education curriculum for pharmacists was developed. Implementation The network grew to > 150 participants across all disciplines and sectors. Quickcards were adjusted, approved and implemented by the network during interquartile meetings. Certified education was implemented and became a requirement for participating pharmacists. Evaluation The quickcards on medication plan and drug-drug-interactions were approved to be useful and feasible by the network by unanimous assent. Overall satisfaction with certified education was high (mean of 1.4 on a scale between 1 = high and 6 = low). Conclusion A regional interprofessional PD network with pharmacists was established and new standards were established. Future research needs to measure the effects on patient outcomes.
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Affiliation(s)
- Olaf Rose
- Impac2t Research, Maximilianstr. 31-33, Münster, Germany.
| | | | - Tessa Huchtemann
- Department of Neurology, University of Münster, Münster, Germany
| | - Constanze Mönig
- Department of Neurology, University of Münster, Münster, Germany
| | - Michael Ohms
- Klinik für Neurologie mit Klinischer Neurophysiologie, Herz-Jesu-Krankenhaus Hiltrup, Westfalenstr. 109, Münster, Germany
| | | | - Tobias Warnecke
- Department of Neurology, University of Münster, Münster, Germany
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Eickhoff C, Griese-Mammen N, Müeller U, Said A, Schulz M. Primary healthcare policy and vision for community pharmacy and pharmacists in Germany. Pharm Pract (Granada) 2021; 19:2248. [PMID: 33520040 PMCID: PMC7844970 DOI: 10.18549/pharmpract.2021.1.2248] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Germany is the highest populated country in Europe with a population of 82.3 million in 2019. As in many other developed countries, it has an aging population. Approximately 10% of the gross domestic product is spent on healthcare. The healthcare system is characterized by its accessibility. Patients are generally free to choose their primary care physicians, both family doctors and specialists, pharmacy, dentist, or emergency service. Up to a certain income, health insurance is mandatory with the statutory health insurance (SHI) system, covering 88% of the population. Major challenges are the lack of cooperation and integration between the different sectors and healthcare providers. This is expected to change with the introduction of a telematic infrastructure that is currently being implemented. It will not only connect all providers in primary and secondary care in a secure network but will also enable access to patients' electronic record/medical data and at the same time switch from paper to electronic prescriptions. Approximately 52,000 of the 67,000 pharmacists are working in approximately 19,000 community pharmacies. These pharmacies are owner-operated by a pharmacist. Pharmacists may own up to three subsidiaries nearby to their main pharmacy. Community pharmacy practice mainly consists of dispensing drugs, counselling patients on drug therapy and safety, and giving advice on lifestyle and healthy living. Many cognitive pharmaceutical services have been developed and evaluated in the past 20 years. Discussions within the profession and with stakeholders on the national level on the roles and responsibilities of pharmacists have resulted in nationally agreed guidelines, curricula, and services. However, cognitive services remunerated by the SHI funds on the national level remain to be negotiated and sustainably implemented. A law passed in November 2020 by parliament will regulate the remuneration of pharmaceutical services by the SHI funds with an annual budget of EUR 150 million. The type of services and their remuneration remain to be negotiated in 2021. The profession has to continue on all levels to advocate for a change in pharmacy practice by introducing pharmacy services into routine care.
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Affiliation(s)
- Christiane Eickhoff
- RPh, PhD. Division Scientific Development, Department of Medicine, Federal Union of German Associations of Pharmacists (ABDA). Berlin (Germany).
| | - Nina Griese-Mammen
- RPh, PhD. Head, Division Scientific Evaluation, Department of Medicine, Federal Union of German Associations of Pharmacists (ABDA). Berlin (Germany).
| | - Uta Müeller
- RPh, PhD. Head, Division Scientific Development. Department of Medicine, Federal Union of German Associations of Pharmacists (ABDA). Berlin (Germany).
| | - André Said
- RPh, PhD. Head, Office of the Drug Commission of German Pharmacists, Department of Medicine, Federal Union of German Associations of Pharmacists (ABDA). Berlin (Germany).
| | - Martin Schulz
- RPh, PhD, FFIP, FESCP. Adjunct Professor. Director, Department of Medicine, Federal Union of German Associations of Pharmacists (ABDA). Berlin (Germany).
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Dietrich FM, Hersberger KE, Arnet I. Benefits of medication charts provided at transitions of care: a narrative systematic review. BMJ Open 2020; 10:e037668. [PMID: 33093031 PMCID: PMC7583078 DOI: 10.1136/bmjopen-2020-037668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Particularly at transitions of care points information concerning current medication tends to be incomplete. A medication chart that contains all essential information on current therapy is likely to be a helpful tool for patients and healthcare providers. We aimed to investigate any type of benefits associated with medication charts provided at transition points. METHODS A systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. Two databases, two online journals and two association websites dedicated to biomedicine and pharmacy issues were consulted to identify studies for the review using the search term 'medication chart' and synonyms. We run our search from database inception up to March 2019. Studies of any study design, intervention and population which examined the effect of paper-based medication charts were included. We extracted study results narratively and coded and classified them by themes and categories inductively by using the 'framework method' with content analysis. The methodological quality of the studies was assessed using the Effective Public Health Practice Project (EPHPP) tool. RESULTS From the 846 retrieved articles, 30 studies met the inclusion criteria, mostly from Germany (18 studies) and the USA (5 studies). Thirteen studies reported a statistically significant result. In the 'patient theme', the most obvious benefits were an increase in medication knowledge, a reduction of medication errors and higher medication adherence. In the 'interdisciplinary theme', a medication chart represented a helpful tool to increase communication and inter-sectoral cooperation between healthcare providers. In the 'theme of terms and conditions', accuracy and currency of data are prerequisites for any positive effect. The quality of the studies was classified predominantly weak mainly due to unmet good quality criteria (no randomised controlled trials study design, no reported dropouts). CONCLUSION Overall, the reviewed studies suggested some benefits when using medication charts. Healthcare providers could consider using medication charts in their counselling practice. However, it is unknown whether the reported benefits lead to measurable improvement in clinical outcomes. PROSPERO REGISTRATION NUMBER.
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Affiliation(s)
- Fine Michèle Dietrich
- Pharmaceutical Science, Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
| | - Kurt E Hersberger
- Pharmaceutical Science, Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
| | - Isabelle Arnet
- Pharmaceutical Science, Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
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14
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[Information technology and eHealth to improve patient safety]. Internist (Berl) 2020; 61:460-469. [PMID: 32236764 DOI: 10.1007/s00108-020-00780-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient safety is a key element of high-quality healthcare. Digitalization, new eHealth applications and data-based algorithms have high potential to make a significant contribution. This article presents current technological developments along a simplified patient journey from emergency medical triage, diagnosis and therapy to follow-up. The technical interventions are highly diverse and mostly accompanied by a low level of evidence, since most of them are from single academic projects or start-ups. Although there should be no doubt that technology is an important instrument for increasing patient safety, new technologies also involve new risks. Furthermore, technical measures must always be embedded in an overall concept of organizational measures, adequate education, training and accompanying research in order to generate the highest possible benefits and lowest possible risks.
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Mueller MA, Opitz R, Grandt D, Lehr T. The federal standard medication plan in practice: An observational cross-sectional study on prevalence and quality. Res Social Adm Pharm 2020; 16:1370-1378. [PMID: 32061549 DOI: 10.1016/j.sapharm.2020.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/16/2020] [Accepted: 01/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Medication plans are instruments used to document drug therapies, guide patients, and ensure medication safety. In Germany, patients who take at least 3 long-term medications are eligible to receive a medication plan. It has been statutory to use the federal standard layout (German: "Bundeseinheitlicher Medikationsplan") since April 2017. OBJECTIVES This study explores the prevalence, availability, medication discrepancies, and conformance with statutory regulations of medication plans since the introduction of the format of the federal standard medication plan in Germany. METHODS Medication reconciliation was performed for hospitalized patients according to the Best Possible Medication History principle. The collected medication lists were analyzed for medication discrepancies and conformance with the statutory regulations. The medication discrepancies were (1) omitted drugs, (2) additional drugs, and (3) dosing errors. RESULTS After hospitalization, 524 patients taking drugs were included. The majority (n = 424 patients) were eligible for a medication plan. While 241 medication lists were present, only 24.1% (n = 58) matched the federal standard format. The mean number of drugs was 6.3 ± 3.6, with 3315 medications (3046 long-term and 269 as needed) reconciled totally. The 84 medication lists with omitted or additional drugs included 166 medication discrepancies upon 774 drugs listed. Of the 253 patients with dosing errors, 146 had a medication list. Inappropriate dosages were due to single dose (n = 195), daily dose (n = 225) or frequency of application (n = 255). CONCLUSION Medication plans are valuable tools for patients and health care providers. This study shows that the introduced paper-based federal standard medication plan in Germany falls short of its expectations regarding availability and correctness. Switching to an electronic patient record system may overcome some of the current pitfalls.
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Affiliation(s)
| | - René Opitz
- Clinical Pharmacy, Saarland University, Campus C2.2, 66123, Saarbruecken, Germany
| | - Daniel Grandt
- Klinikum Saarbruecken gGmbH, Clinic for Internal Medicine (I), Winterberg 1, 66119, Saarbruecken, Germany
| | - Thorsten Lehr
- Clinical Pharmacy, Saarland University, Campus C2.2, 66123, Saarbruecken, Germany.
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