Discrepancies and changes during the initial medication review in the programme ARMIN: What do pharmacists and physicians contribute?
- At: PPR 2022 (2022)
- Type: Poster
- By: STRUNZ, Ann Kathrin (ABDA - Federal Union Of German Associations Of Pharmacists, Department Of Medicine)
- Co-author(s): Ann Kathrin Strunz, ABDA - Federal Union Of German Associations Of Pharmacists, Department Of Medicine
To optimize drug therapy, patients with polymedication participated in an interprofessional intervention provided by community pharmacists (CP) and general practitioners (GP) in the German programme ARMIN. The intervention started with a standardized medication review involving different data sources – patient, CP, GP and health insurance fund. The initial brown bag review by the CP included a pharmaceutical risk assessment followed by an assessment by the GP. The resulting consolidated medication plan (MP) was printed out for the patient.
To analyze discrepancies and changes in the patients’ medication during different phases of the medication review and to evaluate the contribution of CP and GP to the consolidated MP.
We aimed to recruit a convenience sample of 60 patients. Discrepancies and changes in the medication were analyzed using the medication discrepancy taxonomy MedTax (Almanasreh E et al. RSAP 2020). We compared (1) the patient-stated medication documented by the CP during the brown bag review versus (2) the provisional MP prepared by the CP, as well as (2) versus (3) the consolidated MP verified by the GP. Additionally we evaluated changes with regard to six common therapeutic indications, grouped by ATC levels.
Altogether, 79 patients were included (54% female), with a mean number of 10.2 medications (median: 9; range: 5–27) on the consolidated MP (3). Almost 70% of drugs on the MP belonged to six therapeutic indications: cardiovascular system (n=221; 28.4%), pain (n=76; 9.8%), bloodsugar (n=69; 8.9%), alimentary tract (n=67; 8.6%), blood coagulation (n=48; 6.2%), and cholesterol (n=46; 5.8%).
We identified 796 discrepancies and changes in total: 605 during the initial CP intervention, (1) versus (2), and 191 during the GP intervention, (2) versus (3).
In accordance with that, drugs in all six most common indications were more often changed during the CP intervention compared to the GP intervention. Most often changes affected drugs for the cardiovascular system (CP: n=140; GP: n=74) and accounted for almost 40% of all changes during the GP intervention.
Changes during the CP intervention most frequently related to drug intake with food (n=165; 27.3%), indication (n=147; 24.3%), or dosing regimen (n=131; 21.7%). During the GP intervention, most frequent changes affected the dosing regimen (n=44; 23.0 %), addition of new drugs (n=34; 17.8%), or instructions (n=33; 17.3%). Drug omissions were most often identified during the CP intervention (n=62; 10.3%) and most often involved drugs against pain (n=10, 16.1%), acting on the alimentary tract (n=7; 11.3%), or the cardiovascular system (n=7; 11.3%). During the GP intervention, 15 drugs (7.9% of the GPs’ changes) were omitted from the MPs, mostly affecting the cardiovascular system (n=6; 40.0%) or drugs against pain (n=4; 26.7%).
The number and types of discrepancies and changes varied between CP and GP: Although most changes were identified during CP intervention, often completing or correcting information on administration, indication, or dosing regimen, the GP mainly focussed on dosing regimen and addition of new drugs. This indicates that both healthcare professionals add value to obtain a comprehensive overview on the patients’ entire medication.