Detection of drug related problems in an interdisciplinary health care model for rural areas in Germany

Abstract

The disparity between an increasing complexity of patients' treatment and the declining number of general practitioners (GP) require action. The AGnES-concept (general practitioner-relieving, community-based, e-health assisted, systemic intervention) is based on the delegation of original physician-activities to qualified AGnES-practice assistants. Purposes of AGnES part 1 were to determine the feasibility of community-based home medication reviews (HMR) and the establishment of a health professional network to identify drug related problems (DRP) in the domicile of elderly patients. Two consecutive studies (AGNES 2 + 3) were conducted to implement HMR. General practices on the isle of Rugia in Mecklenburg-Western Pomerania, a German rural area. Patients who receive regular home visits by their GP were addressed. Study-instruments for the feasibility study (AGnES 1) were designed by an expert panel and modified for the implementation (AGnES 2 + 3) studies. HMR were conducted by additionally qualified AGnES-practice assistants regarding DRP like drug-drug interaction (DDI), adverse drug reactions (ADR), and compliance. DRP-selection was inspired by the coding system Pi-Doc. Pharmacists checked DRP and intervened, if necessary. 18 (AGnES 1) and 60 (AGnES 2 + 3) geriatric patients received a minimum of two home visits by an AGnES-practice assistant. Feasibility was assessed by patients' satisfaction with care provided by the AGnES-practice assistant. For implementation reported DRP and the conducted interventions were evaluated. During AGnES 1 a documentation sheet was developed and tested. 56 potential DDI were identified. 37 of 112 drugs which caused potential interactions were attributed to OTC medication and food components. 84% of respondents judged the systematic evaluation of their pharmacotherapy as helpful. During AGnES 2 + 3 local pharmacists identified DDIs in 45% of patients. Seven patients (11.6%) reported at least one ADR attributable to their current medication. Those patients who received a second HMR (n = 29) during AGnES 2 + 3 rated the HMR as reasonable 65.5% (n = 19), and partly reasonable 24.1% (n = 7). By comprehensive HMR conducted by AGnES-practice assistants in delegation of the patients' GPs in cooperation with local pharmacists we could identify a considerable prevalence of DRP under real-life conditions. Further studies should recruit more participants including a control group with usual care.