German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Ellernholzstreet 1/2, 17487, Greifswald, Germany,
Int J Clin Pharm. 2013 Oct;35(5):763-71. doi: 10.1007/s11096-013-9804-x. Epub 2013 Jul 14.
Drug related problems (DRPs) are impairing patients' health and cause high costs. Neither delegation of home medication review nor regular pharmaceutical care are common in Germany.
We aimed to reduce several DRP by the implementation of a three party healthcare team [AGnES-practice assistant, pharmacist, general practitioner (GP)] and adherence supporting strategies (using a medication reminder chart, medication compliance aid).
The setting was ambulatory primary healthcare in German rural areas with a cohort of home-dwelling, elderly, mostly multimorbid patients with limited mobility (study period: 06/2006-12/2008).
We conducted a prospective non-randomized implementation cohort study with home medication review (home medication review module; mean participation time: 9 months). Data collection was delegated to additionally qualified AGnES-practice assistants (AGnES: GP-supporting, community-based, e-health-assisted systemic intervention). The intervention comprised pharmaceutical care by the local pharmacy in addition to medical interventions by the GP. 408 patients (mean age: women: 80.7 years; men: 75.3 years) received both pharmaceutical care and at least one follow-up visit.
Outcome measurements comprised self-reported DRPs, objectively evaluated DRP, and prevalence of adherence supporting strategies.
The three party healthcare team approach reduced self-reported forgetfulness (7.7-3.2 %; p = 0.001), the proportion of patients with intermittent drug intake (5.3-1.3 %; p < 0.001), and the proportion of patients with potentially clinical relevant drug-drug interaction (61.6-51.2 %; p < 0.001). Self-reported adverse drug reactions decreased non-significantly (5.4-4.6 %; p = 0.564; all tests χ²-McNemar). The median number of active substances taken was reduced from 8 to 7 (p < 0.001; Wilcoxon signed rank test). The proportions of patients using medication charts and compliance aids increased significantly (75.2-90.3 %; p < 0.001) and (70.0-80.1 %; p > 0.001), respectively.
This is the first study evaluating effects of a three party team on DRPs in a primary healthcare setting in Germany. This approach led to reduction in the occurrence of several DRPs and improved adherence supporting strategies. However, the study is a pre-post analysis, and had no control group.
药物相关问题（DRP）正在损害患者的健康并导致高昂的成本。在德国，既没有委托家庭药物审查，也没有常规的药物护理。
我们旨在通过实施三方医疗团队[AGnES-实践助手、药剂师、全科医生（GP）]和采用药物提醒图表、药物依从性辅助工具等依从性支持策略，减少多种 DRP。
该研究在德国农村地区的门诊初级保健中进行，参与者为居住在家庭中的、年老的、大多患有多种疾病且行动不便的患者（研究期间：2006 年 6 月至 2008 年 12 月）。
我们进行了一项前瞻性、非随机实施队列研究，进行家庭药物审查（家庭药物审查模块；平均参与时间：9 个月）。数据收集委托给了额外合格的 AGnES-实践助理（AGnES：支持全科医生、基于社区、电子健康辅助的系统性干预）。干预措施包括当地药房的药物护理以及 GP 的医疗干预。共有 408 名患者（平均年龄：女性：80.7 岁；男性：75.3 岁）接受了药物护理和至少一次随访。
观察指标包括自我报告的 DRP、客观评估的 DRP 和依从性支持策略的流行率。
三方医疗团队方法减少了自我报告的健忘症（7.7-3.2%；p=0.001）、间歇性药物摄入的患者比例（5.3-1.3%；p<0.001）和具有潜在临床相关药物-药物相互作用的患者比例（61.6-51.2%；p<0.001）。自我报告的不良反应虽有所下降，但无统计学意义（5.4-4.6%；p=0.564；所有检验 χ²-McNemar）。正在服用的活性物质数量中位数从 8 种减少到 7 种（p<0.001；Wilcoxon 符号秩检验）。使用药物图表和依从性辅助工具的患者比例显著增加（75.2-90.3%；p<0.001）和（70.0-80.1%；p>0.001）。
这是在德国初级保健环境中评估三方团队对 DRP 影响的第一项研究。该方法导致多种 DRP 的发生减少，并改善了依从性支持策略。然而，该研究是一项前后分析，且没有对照组。
