Untersuchung des Einflusses einer Medikationsanalyse auf die Therapie von Patienten mit Typ-2-Diabetes in öffentlichen Apotheken in Deutschland (DIATHEM-Studie)

Patienten mit Typ-2-Diabetes im geriatrischen Alter sind chronisch kranke Patienten, häufig zusätzlich belastet durch Multimorbidität und Polymedikation. Studien aus anderen Ländern zeigen, dass Typ-2-Diabetiker von einer interprofessionellen Medikationsanalyse profitieren können und diese Intervent...

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Bibliographic Details
Main Author: Schindler, Elisabeth
Contributors: Culmsee, Carsten (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2020
Online Access:PDF Full Text
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Most elderly patients with type 2 diabetes take multiple drugs. Earlier studies in other countries suggested that interdisciplinary medication reviews are beneficial for these patients regarding medication safety and therapy optimization. In Germany, medication reviews by community pharmacies are rarely performed, although it is a service stipulated in the “Apothekenbetriebsordnung” (rules governing the operation of pharmacies in Germany) since 2012. Therefore, the aim of the DIATHEM study (type 2 DIAbetes: optimizing THErapy by Medication review in community pharmacies) was to evaluate the impact of medication reviews from German community pharmacies under real-life conditions. Primary outcomes were: identification of drug related problems (DRP) and to evaluate to what extent they could be solved by the medication review. Secondary outcomes were: evaluation of changes in the number of drugs and the interdisciplinary cooperation between pharmacists and physicians. In this single arm interventional study, patients aged 65 or older with type 2 diabetes, taking at least five drugs for long-term treatment were provided with one medication review type 2a or 2b between February 2016 and April 2017. Identified DRP were categorized using the PCNE (Pharmaceutical Care Network Europe) classification for drug-related problems V9.0 and a DRP-classification by the Federal Union of German Associations of Pharmacists (Bundesvereinigung Deutscher Apothekerverbände, ABDA). Physicians were not pre-informed about the review and neither patients nor physicians nor the 13 participating community pharmacies were reimbursed for their contributions to the study. For 121 patients, 586 DPR were identified (4.84 DRP per patient; standard deviation (SD) = 2.7) of which 31.6% were related to the antidiabetics. Due to the medication review, 46.9% of these DRP could be completely resolved, indicating a statistically significant decline of 2.27 DRP (SD = 2.3) per patient (p < 0.001). The average number of drugs was statistically significantly reduced from 9.5 drugs (SD = 2.9) to 9.3 drugs (SD = 2.8) per patient (p = 0.001). The pharmacists received feedback for 76.7% of the intervention proposals sent to the physicians, the overall cooperation rate was 64.0%. In total 59.5% of the intervention proposals were accepted, of which 85.3% were accepted and fully implemented. In conclusion, the study shows that medication reviews performed by community pharmacists under routine care conditions reduced the frequency and number of DRP, even though the pharmacies had to face obstacles such as lack of cooperation by the prescriber or lack of reimbursement. Overcoming these obstacles will provide an enormous benefit to patients, the pharmacy profession and the health care system.