Short and mid-term impact of community pharmacy-based medication reviews on medication- and patient-related outcomes in Germany.

OBJECTIVE: To assess the effect of a routine medication review service in German community pharmacies (ATHINA) on drug-related problems (DRPs) and patient-related outcomes. MATERIALS AND METHODS: From 2015 to 2017, ATHINA patients were invited by their pharmacists to participate in a prospective, observational trial, meaning that they needed to attend to a follow-up visit (T2) 3 - 6 months after the routine ATHINA baseline (T0) and concluding visit (T1) to assess implementation rates of the pharmacists' interventions. Moreover, they were asked to fill in 2 surveys on drug treatment-related quality of life and satisfaction with the amount of information received about medicines at T0, T1, and T2. RESULTS: Of 132 recruited patients, 115 completed T2. At T0, pharmacists documented a DRP or information need for 114 of 115 patients. About half of these issues were resolved leading to 43/115 patients without any DRP or information need at T1 and 50/115 patients without any DRP or information need at T2 (i.e., absolute reduction by 42.6%, p < 0.001). Also, the number of patients who felt that their daily life was not impaired at all or only very slightly by their drug treatment increased from 54.7% (58/106) at T0 to 67.6% (73/108, p = 0.011) at T2. While the overall satisfaction score with the amount of information on medicines increased from 10.2 ± 5.5 at T0 over 14.6 ± 3.8 (T1) to 15.4 ± 3.1 (T2, p < 0.001), this increase did not correlate with reduced information needs. CONCLUSION: The results suggest that the intervention improves medication- and patient-related outcomes. However, causal relationships are still questionable.

Preserved Contextual Cueing in Realistic Scenes in Patients with Age-Related Macular Degeneration.

Foveal vision loss has been shown to reduce efficient visual search guidance due to contextual cueing by incidentally learned contexts. However, previous studies used artificial (T- among L-shape) search paradigms that prevent the memorization of a target in a semantically meaningful scene. Here, we investigated contextual cueing in real-life scenes that allow explicit memory of target locations in semantically rich scenes. In contrast to the contextual cueing deficits in artificial scenes, contextual cueing in patients with age-related macular degeneration (AMD) did not differ from age-matched normal-sighted controls. We discuss this in the context of visuospatial working-memory demands for which both eye movement control in the presence of central vision loss and memory-guided search may compete. Memory-guided search in semantically rich scenes may depend less on visuospatial working memory than search in abstract displays, potentially explaining intact contextual cueing in the former but not the latter. In a practical sense, our findings may indicate that patients with AMD are less deficient than expected after previous lab experiments. This shows the usefulness of realistic stimuli in experimental clinical research.

[Retrospective Study of Long-term Patient Satisfaction after Bilateral Implantation of Multifocal Intraocular Lenses of Different Generations - a 10 Year Follow-up]. / Patientenzufriedenheit nach Implantation von Multifokallinsen verschiedener Generationen ­ ein 10-Jahres-Follow-up.

BACKGROUND: This retrospective study investigates the postoperative satisfaction of patients with a mixed generation background after bilateral implantation of non-toric multifocal intraocular lenses between the year 2006 and year 2017. PATIENTS/METHODS: 245 patients between 45 and 95 years old were included in the study. Patient satisfaction was examined with the Heidelberg DATE questionnaire (DATE: Daily Tasks Evaluation), with respect to everyday tasks and the perception of optical phenomena. All criteria of the questionnaire were assessed for significant differences with respect to the time of the operation, the age of the patient, gender as well as the model of the implanted intraocular lens. The data was analysed with the statistics software SPSS 23.0. RESULTS: At the time of the survey, 97.1% of patients reported they were completely or partially satisfied with the outcome of the operation. 95.9% of patients could accomplish all common tasks without any significant problems. 34.6% said they only needed glasses under very challenging visual circumstances. The older patients more often reported that they needed glasses (p < 0.01). Women wore glasses more frequently for driving during night than men. They also described dazzling as more disturbing (p < 0.03). Younger patients perceived halos more drastically than older patients (p < 0.01). Patients with bifocal lens implants used glasses for intermediary distances far more often than patients with trifocal implants (p < 0.01). CONCLUSION: Most patients were independent of additional optical correction. Optical phenomena are commonly reported, so extensive preoperative briefing is inevitable. The need for further information seems to be especially high among younger, female patients. The Heidelberg DATE questionnaire is well suited for surveying patient satisfaction after the implantation of multifocal intraocular lenses.

Medication review in German community pharmacies - Post-hoc analysis of documented drug-related problems and subsequent interventions in the ATHINA-project.

BACKGROUND: Any medication can cause drug-related problems (DRPs), which can often be detected by medication reviews. So far, only limited information is available on the practicability of systematic medication reviews in community pharmacies in daily routine and their value in Germany. Since 2012, the community pharmacy-centered medication review project "ATHINA - Arzneimitteltherapiesicherheit in Apotheken [medication safety in community pharmacies]" is endorsed by four Chambers of Pharmacists in Germany. The aim of this evaluation was to post-hoc analyze the nature of medication reviews performed in ATHINA. METHODS: For this analysis, information from anonymized, structured documentation sheets of medication reviews performed from 2012 to 2015 were analyzed. Documentation sheets contained demographic information of the patient, the patient's medication, and structured information on any information need or DRP identified for a specific drug, the pharmacists' actions taken with regard to the identified problem (e.g. contact with a physician), and whether the problem was ultimately resolved completely, partly, or not at all. RESULTS: Overall, 241 pharmacists documented 912 medication reviews with on average 10.8 ± 3.6 drugs. In 869 reviews (95.3%), the pharmacist documented at least one drug with information need or DRP. In 75.7% (N = 3972/5248) of the drugs with at least one information need or DRP, the pharmacists documented the action taken to solve the problem. At the end of the medication review, 359 (39.4%) of the cases had only drugs with resolved or no identified problems. Overall, the ratio of DRPs per drug regimen was reduced from 56% ± 22.7 drugs with at least one information need or DRP in the beginning to 28.9% ± 18.3 in the end. CONCLUSION: This analysis indicates that community pharmacists can deliberately identify patients with information needs and DRPs and solve many of these problems in the course of a medication review.