Article
Development and evaluation of an algorithm in Medication Management for best practice. Effectiveness of the intervention and translation into standard care for nursing home residents – AMBER-Study, study design
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Published: | November 23, 2016 |
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Background: Medication Therapy Management is an international well established tool of pharmaceutical care to increase therapy quality [1], [2], [3]. In Germany this service is not part of current standard care and is not established in everyday practice.
Residents of nursing home facilities are a vulnerable patient group for medication risk [4], [5]. Old age, need for care, multimorbitiy and polymedication are common risk factors [6], [7]. Fall hazard, hospitalization and numerous general practitioner contacts can be linked to inappropriate medication [8], [9], [10]. To support pharmacists in performing a structured Medication Review and to find and solve frequent and relevant problems in an appropriate timeframe, an algorithm is developed and evaluated.
Materials and Methods: In study phase I interviews with patients, physicians, pharmacists and nurses in North Rhine-Westphalia are performed with the aim of addressing relevant medication problems. In phase II an algorithm for Medication Reviews is developed based on the qualitative results of phase I, and considering the outcomes of international studies. The algorithm is applied and tested for practicability and effectiveness in phase III in an open, single arm, interventional study. The following inclusion criteria are defined: patients age ≥65 years, residency in a nursing home facility, multimorbidity (at least 2 chronic diseases), polymedication (at least 5 chronic systemic available medications) and signed informed consent. Participation in other clinical studies at present time is an exclusion criterion.
Several patient cases are reviewed by clinical experts and by community pharmacists using the algorithm. Translation into daily practice and feasibility are assessed by comparing the obtained drug-related problems.
The primary and secondary endpoints will be defined according to the results of study phase I. Drug-related problems and acceptance of the suggestions by general practitioners and nurses are evaluated.
Results: Results are not yet obtained.
Conclusion: It is expected that the algorithm detects relevant drug related problems, reduces medication risks and optimizes drug therapy. The algorithm is designed to support the pharmacist with a structured approach on relevant aspects translated to nursing-home patient care, considering limited time in daily practice.
A research grant was provided by the noncommercial foundation "Apothekerstiftung Westfalen-Lippe".
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