Structured Pharmacotherapy in Multimorbid Seniors – a Pilot Project

DOI: 10.3238/zfa.2017.0266-0270

german translation / full article

Jost Steinhäuser, Svante Christoph Gehring, Johannes Kandzora, Elke Jeske-Saathoff, Sonja Laag, Werner Hofmann

Keywords: multimorbidity polypharmacy bottom-up quality circle drug safety

Background: Patients who suffer from multiple diseases and take more than five drug substances, are common in daily family practice. Besides the guideline multimedication there are very few recommendations for these patients. Therefore between 2008 and 2014 physicians from northern Germany developed bottom-up an algorithm for more safety regarding polypharmacy and performed a pilot project to test the feasibility. Aims were to get age- and risk-adapted disease specific medication plans.

Methods: Experience from quality circles and semi structured literature searches were part of the algorithm which included geriatric and prognostic aspects and the handling of potentially inadequate medication. In order to minimize the influence of seasonal factors, 2nd quarter of each year drug prescription data of patients insured with the Barmer GEK were evaluated from before the start in 2012 up to the end of the project in 2014.

Results: Between 2012 and 2014, 92 patients from 11 practices taking more than five drugs participated. Patients had on average 15 ICD10 diagnosis (minimum 2, maximum 44), average age was 76, 57 % were female. In 2012 patients had 6.59 permanent prescriptions, in 2014: 4.02.

Conclusions: The algorithm was feasible to use. To what extent the observed reduction of the number of prescriptions is causally related to the algorithm should be tested within a controlled design.

(State: 19.06.2017)

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