Verbesserung der Adhärenz in der medikamentösen Therapie bei Patienten mit Hypercholesterinämie durch die erweiterte pharmazeutische Betreuung in der öffentlichen Apotheke

Statine sind weltweit die am häufigsten angewandten Arzneimittel bei Hypercholesterinämie. Der Erfolg der Therapie mit Statinen ist allerdings durch die schlechte Adhärenz der Patienten eingeschränkt. In der ADSTAPHARM-Studie (ADhärenz von STAtin-Patienten bei PHARMazeutischer Betreuung) wurden die...

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Bibliographic Details
Main Author: Grintz, Michael
Contributors: Culmsee, Carsten (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Language:German
Published: Philipps-Universität Marburg 2024
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Statins are the most commonly used drugs for hypercholesterolemia worldwide. However, the therapy outcome is limited predominantly due to poor adherence. In the presented ADSTAPHARM study (ADherence of STAtin patients under PHARMaceutical care), the short- and long-term effects of a medication review in the community pharmacy on the adherence of statin patients were investigated. At the same time, the effect of the medication review on drug-related problems (DRP) was analyzed. The ADSTAPHARM study enrolled 390 patients, 122 of whom underwent a medication review. The other patients either received an individual medication list (n = 140) or served as a control group (n = 128). For the 122 patients, the number of DRP was significantly reduced by 47% after the medication review. A medication review can therefore recognise and, to a large extent, eliminate ABP, thereby contributing to drug therapy safety. Adherence was analyzed using the Medication Possession Ratio (MPR). It was found that the median MPR of the patients increased significantly to 1.0 after the medication review, indicating optimal adherence. It can therefore be concluded that the medication review has the potential to improve the adherence of statin patients and thus elevate drug therapy safety. The patients receiving the medication list demonstrated a significant improvement following the receipt of the medication list (median MPR: 0.86). Therefore, it is legitimate to assume that the medication list had a reminder character for the enrolled patients. The control group showed significant fluctuations in the MPR. The median MPR increased from an initial 0.41 to 0.64 at the first measurement point. It should be emphasized that the median MPR of the control group is below 0.8 at all relevant time points and thus the patients in the control group do not reach the threshold value to be classified as adherent. Furthermore, it should be noted that the median MPR of the control group was below the median MPR of both study populations (subgroups receiving either a medication review or an individual medication list) at all observation time points except for the time point after five years. All categories showed a comparable MPR after five years and no significant difference in MPR was observed between baseline and endpoint in all categories, indicating that the effects of the medication review and medication list were short-lived. The effects of the medication review on patients with vs. without polymedication, men vs. women and atorvastatin vs. simvastatin patients were also analyzed. It was shown that there was no significant between-group difference in baseline adherence and in the period directly after the medication review. Accordingly, no subgroups could be identified that should be explicitly focussed on in adherence management in the slope of a medication review. Instead, it was shown that patients who were non-adherent at the start of the study benefited particularly from the medication review in terms of their adherence. Overall, the results of the ADSTAPHARM study suggest that the medication review in the community pharmacy has the potential to significantly reduce DRP and improve the adherence of statin patients, although the positive effects seem to be limited over time.