Der Einfluß des Apothekers auf die Therapie chronischer Wunden

The therapy of chronic wounds is a multifactorial process, the affected patients are old and multimorbid. 75% of the wounds are vascular caused, often accompanied with diseases like diabetes, high blood pressure and other metabolism diseases, as well as abusus of nicotin and adipositas complicate the healing of leg ulcers. With the traditional approaches and measures to treat acute diseases optimum results cannot be achieved because of the huge number of negative influence (BIAS). With this work the put up hypothesis that the influence of the pharmacist on the therapy of chronic wounds can improve the success and the costs of the treatment should be proved. Beside the head - and the accompanying diseases - other parameters have an important influence on the healing course. The resultant (co) medications, the choice of the right wound dresses as a function of the state of the wound and the compliance of the patients have a big influence on the therapy success. By a fine-meshed, complete (photo) documentation, the pharmacist has the newest information about the state of the wound or the course of the sore healing. As a "case manager" he can always intervene if necessary in a contemporary way. Side effects caused by a change of the accompanying medication, allergic reactions or infections can become walked thus in terms of "pharmaceutical care" actually. The pharmacist rates information from different sources: physiology or pathophysiology of the wound, pharmacology or medication, as well as the accompanying medication. Compliance, nutritional condition, and right use of the chosen products also play an important role. Then from the judgement of the whole situation the initiated measures occur strictly defined standards or guidelines. The evidence of the hypothesis was proofed by study, following a defined design. After a concluded diagnostics (differential diagnostics, vascular status) and all necessary measures to the causal therapy, the patients were linked up structured from the clinic. Directly at the interface clinical and ambulant sector, the affected persons were taken up in the programme, all partners in the ambulant sector were informed about the model. All relevant data were taken - following the data protection - from the doctor´s letters -were collected centrally and stored. The therapy recommendation by the clinic occurred after a defined standard, following the principle of the phase-adapted modern wound care. In the ambulant sector the pharmacist was responsible for choice and proper application of the wound dresses. Finding price corridors within a product group or a "Festbetragsregelung" according to the model of generic groups with medicaments creates only low savings per patient per year and hinders using special qualities of the single sore editions suitably to the wound. 95% of the leg ulcers got closed, 1% of the patients reached a stable wound situation and with 4% an amputation was unavoidable. The arithmetic middle 90 days up to closure lies within the range of the definition of a chronic wound. The 3rd quality criterion is the avoidance of a reappearance which was also fulfilled with a rate <6%. The comparison of the structured approach in the wound competence net to the approach of the control group shows, that savings of more than 70%. were achieved for material costs. The whole cost of materials up to the sore end amounts to 323.70 euros plus tax. The projected saving for the region "Mittlerer Oberrhein" would be 2.000.000 euros a year. The results show that the pharmacist can play as a "case manager" linked with a professional "pharmaceutical care". He contributes to a positive influence on the medical, nursing and economical aspects of the therapy.