Drug-related problems in community-dwelling primary care patients screened positive for dementia.

D Wucherer,S Richter,J R Thyrian,W Hoffmann,J Hertel,I Kilimann,I Zwingmann,A Dreier-Wolfgramm,C A Ritter,B Michalowsky,S Teipel,T Eichler

doi:10.1017/s1041610217001442

Abstract

Older people have a higher risk of drug-related problems (DRPs). However, little is known about the prevalence of DRPs in community-dwelling people who screened positive for dementia. Our study aimed to determine (1) the prevalence and types of DRPs and (2) the socio-demographic and clinical variables associated with DRPs in people screened positive for dementia in primary care. The Dementia: life- and person-centered help in Mecklenburg-Western Pomerania (DelpHi-MV) study is a general practitioner (GP)-based cluster-randomized controlled intervention study to implement and evaluate an innovative concept of collaborative dementia care management in the primary care setting in Germany. Medication reviews of 446 study participants were conducted by pharmacists based on a comprehensive baseline assessment that included a computer-based home medication assessment. ClinicalTrials.gov Identifier: NCT01401582. A total of 1,077 DRPs were documented. In 414 study participants (93%), at least one DRP was detected by a pharmacist. The most frequent DRPs were administration and compliance problems (60%), drug interactions (17%), and problems with inappropriate drug choice (15%). The number of DRPs was significantly associated with the total number of drugs taken and with a formal diagnosis of a mental or behavioral disorder. Degree of cognitive impairment (MMSE defined) and formal diagnosis of dementia were not risk factors for an increased number of DRPs. However, the total number of drug taken and the presence of a diagnosis of mental and behavioral disorders were associated with an increased total number of DRPs.

Highlights

75% of the 1.5 million people with dementia (PwD) in Germany are communitydwelling patients (Grass-Kapanke et al, 2008)
A high prevalence of drug-related problems (DRPs) in this population would drive the inclusion of systematic medication reviews in dementia care programs
The goals of the present analysis were to determine (1) the frequency and the type of DRPs and (2) the socio-demographic and clinical variables associated with DRPs in people who screened positive for dementia in a German communitydwelling setting

Summary

Introduction

75% of the 1.5 million people with dementia (PwD) in Germany are communitydwelling patients (Grass-Kapanke et al, 2008). Advanced age and impaired cognition increase the risk of DRPs; a prospective multicenter study from the Netherlands identified impaired cognition as one of the main determinants of preventable medication-related hospital admissions in the general population (Leendertse et al, 2008). The goals of the present analysis were to determine (1) the frequency and the type of DRPs and (2) the socio-demographic and clinical variables associated with DRPs in people who screened positive for dementia in a German communitydwelling setting. Little is known about the prevalence of DRPs in community-dwelling people who screened positive for dementia. Our study aimed to determine (1) the prevalence and types of DRPs and (2) the socio-demographic and clinical variables associated with DRPs in people screened positive for dementia in primary care

Methods

Results

Conclusion