Einfluss der Pharmazeutischen Betreuung auf die Versorgungsqualität von Schlaganfall-Patienten im Rahmen einer schnittstellenübergreifenden Nachbeobachtung zwischen Krankenhaus, Reha und ambulantem Bereich (EPASKA-Studie)

Die gesundheitsbezogene Lebensqualität spielt eine entscheidende Rolle bei Patienten mit einer zerebralen Ischämie. Im Rahmen der vorliegenden Arbeit wurde erstmals in Deutsch-land eine schnittstellenübergreifende Follow-up Studie zur Pharmazeutischen Betreuung von Schlaganfall-Patienten entworfen u...

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Bibliographic Details
Main Author: Hohmann, Carina
Contributors: Radziwill, Roland (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2007
Online Access:PDF Full Text
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The health-related quality of life (HQR) is important in patients with ischemic stroke. This study was the first follow-up study in Germany involving an acute hospital, rehabilitation hospitals, community pharmacies and general practitioners for the treatment of stroke patients. Patients with TIA or ischemic stroke, which were treated in the stroke unit / neurological ward of Klinikum Fulda, with a Barthel index over 30 points on discharge from hospital and living at home were included. The patients were divided into an intervention group (IG) and a control group (CG). The assignment of patients to the IG or CG was based on each patient’s community pharmacy of choice. Community pharmacists which are mem-bers of the working group of community pharmacists (38%) in the region of Fulda pro-vided pharmaceutical care for these patients (IG). The other community pharmacists cared for the patients within the CG as usual. 90 patients (35,3%) in the IG and 165 patients (64,7%) in the CG were recruited and the follow-up time was 12 months. The aim of the study was to improve the patient’s health-related quality of life after stroke. The HQL was measured with the Short Form 36 (SF-36) in hospital and 12 months later. Further goals were optimizing the drug therapy to guarantee an effective secondary prevention, to evaluate the patient’s compliance, to identify and resolve drug-related problems, to increase the patient’s knowledge about their medicines and their satisfaction with pharmacists’ recommendations. In hospital the patients of the IG and their relatives received a pharmaceutical care plan, information about their medicines and secondary prevention and a chart of their medica-tion. The general practitioner, the rehabilitation hospital and the community pharmacy got a care plan regarding this patient. Pharmaceutical care was continued by the commu-nity pharmacist for 12 months within this study. After 12 months the HQL of the patients in the CG was significantly decreased in vitality compared to the IG. The health status of the patients in the IG did not change signifi-cantly during the observation period; only the scale “bodily pain” decreased significantly. However, significant decreases could be seen for the CG in 7 of the 8 subscales and in both summary measures of the SF-36 during the study; that means the HQL of the pa-tients in the CG declined during the observation period. After 12 months 85% of the pa-tients in the IG and in the CG were treated with ASA, clopidogrel, ASA plus dipyridamol or phenprocoumon according to the guidelines. In 10.6% of the patients in the IG and 12.4% of the patients in the CG there were drug-related problems, especially no secondary pre-vention and inappropriate duplication of secondary prevention. The compliance of the patients was measured only in the IG with medication profiles. The compliance of all medication was 85.4%. In the IG (n=72 patients) 29 drug-related problems were docu-mented from the community pharmacy and 26 drug-related problems from the pharma-cist at hospital at the evaluation of the data. In the CG (n=152 patients) 45 drug-related problems were documented from the pharmacist at hospital at the evaluation of the data. The knowledge of the patients about their medicines was in the IG significant higher than in the CG; significant more patients of the IG could specify the correct indication to all the medicines. Patients of the IG were significantly more satisfied with the pharmacists’ recommendations than the patients in the CG. The findings of this study demonstrated that an intensive cooperation between pharma-cists and patients with ischemic stroke based on the concept of pharmaceutical care had a positive impact on the HQL, the knowledge about their medicines and the patients’ sat-isfaction. A future integrated care concept should focus on the relationship between hos-pitals, general practitioners and community pharmacies in order to guarantee an effective secondary prevention, to optimize the drug therapy and to identify and solve drug-related problems.