ABSTRACT
BACKGROUND: Pharmacist-led medication reviews are considered a valuable measure to address risks of polypharmacy. The software Medinspector® is used in community pharmacies to assist the performance of this complex service by structuring the medication review process and supporting pharmacists in their decision-making with targeted clinical knowledge. Key feature is a computerized risk assessment of both the initial and adjusted medication regimen of a patient in multiple domains, thus aiming to support the identification and solving of drug-related problems. This study will examine the effects of medication reviews performed with the clinical decision support system in daily routine practice on medication-related and patient-reported outcomes in elderly patients with polypharmacy. METHODS: A prospective, before-after observational study is conducted in German community pharmacies aiming to include 148 patients aged 65 or older, who chronically use five or more active pharmaceutical substances with systemic effects and utilize the software-supported medication review service. The study is based on routine documentation within the software over the course of the medication review, including a patient's baseline medication, the medication proposed by pharmacists, and the final medication regimen. A software-implemented questionnaire comprising self-developed and literature-derived instruments is used to collect patient-reported outcome data at baseline and follow-up. Primary outcome is the appropriateness of medication measured with an adapted version of the Medication Appropriateness Index (MAI). Secondary medication-related outcomes are medication underuse, exposition towards anticholinergic/sedative drugs, number of drugs in long-term use and the implementation of pharmacist-proposed medication adjustments by the physicians. Secondary patient-reported outcomes are symptom burden, medication-related quality of life, adherence, fulfillment of medication review-related goals, and perception of the service. DISCUSSION: With the recently introduced remuneration of community pharmacist-led MR in Germany, the demand for digital tools supporting the MR process is assumed to rise. The OPtiMed-study is expected to create evidence on the effects of a novel tool on patient care in a vulnerable patient population. Trial registration German Clinical Trials Register, DRKS00027410. Registered 22 December 2021, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00027410 . Also available on the WHO meta-registry: https://trialsearch.who.int/?TrialID=DRKS00027410.
ABSTRACT
Background Pharmacists in community pharmacies worldwide successfully conduct an increasing number of medication reviews (MR). Since June 2012 MR are incorporated in the German ordinance on the operation of pharmacies as pharmaceutical service. In November 2014, a German guideline for MR was established. Different teaching programmes for MR were implemented since. Despite these favorable conditions, only few pharmacies conduct MR regularly. OBJECTIVE: Identification of factors necessary for a successful implementation of MR in community pharmacies. SETTING: Community pharmacies located in the area of the Pharmacists' Chamber Westphalia-Lippe (Part of Northrhine-Westphalia, Germany). METHOD: Following a Positive-Deviance approach, telephone interviews were conducted in community pharmacies with pharmacy-owners, MR-trained employed pharmacists, and technicians. Data evaluation was performed using qualitative content analysis. MAIN OUTCOME RESULTS: Successful strategies for implementing MR in community pharmacies. RESULTS: Forty-four interviews were conducted and analysed. Thirty-three success factors were identified. Data analysis revealed two groups of success-factors important for implementation of MR; organisational (n = 25) and individual factors (n = 8). Relevant organisational success-factor were involvement of the entire team with active involvement of technicians, documentation of results in the pharmacy software and training in patient-identification and communication. Restructuring of workflows increased time-periods for MR. Important individual success-factors were: motivation and identification with the service, routine in execution to enhance self-esteem, and specialisation in pharmacotherapy of particular diseases. Pharmacy-owners play a pivotal role as motivators. Professional healthcare attitude, exhibited in daily routine, leads to increased acceptance by patients and practitioners and thus increases implementation-rates considerably. CONCLUSION: We were able to define strategies for successful implementation of MR in community pharmacies.
Subject(s)
Community Pharmacy Services , Pharmacies , Humans , Medication Review , Pharmacists , Professional RoleABSTRACT
Background Pharmacists who engage in Pharmaceutical Care need skills to optimise responsible medication use and increase medication adherence. Objectives We developed and evaluated a blended-learning programme for German community pharmacists that focused on conducting consultations in chronic diseases. Setting Community pharmacists in Germany. Method Interventional study with pre-post design. We combined e-learning with Objective Standardised Clinical Examinations (OSCEs) for emergency situations, initiation/implementation of medication therapy and detection of symptoms of four chronic diseases. Specific procedures were defined in the Pharmaceutical Action Plan. Skills were measured with a global analytical marking sheet derived from the Medication Related Consultation Framework and scored with the Canadian criticality/relevancy matrix. Time limits matched real practice scenarios. Main outcome measures Changes in knowledge (difference of test results before and after e-learning) and changes in skills (difference in scores of the OSCEs before and after training). Results 22 out of the 26 pharmacists enrolled, completed the study. The number of correctly answered questions increased significantly after the e-learning for all four indications with a mean number of additional correct answers between 3.86 and 4.9 points out of 15 (p < 0.001). The sums of the analytical checklist points in percentages increased significantly in all topics from the baseline summative OSCE to the final summative OSCE between 6.14 and 31.85% (p < 0.001). The maximum duration of consultation per patient was less than 10 min in all OSCEs. Conclusion The use of e-learning and OSCEs was well received by participants and is a successful method to deliver practical Pharmaceutical Care training.