Priority Setting and Influential Factors on Acceptance of Pharmaceutical Recommendations in Collaborative Medication Reviews in an Ambulatory Care Setting - Analysis of a Cluster Randomized Controlled Trial (WestGem-Study)

PLoS One. 2016 Jun 2;11(6):e0156304. doi: 10.1371/journal.pone.0156304. eCollection 2016.

Abstract

Background: Medication reviews are recognized services to increase quality of therapy and reduce medication risks. The selection of eligible patients with potential to receive a major benefit is based on assumptions rather than on factual data. Acceptance of interprofessional collaboration is crucial to increase the quality of medication therapy.

Objective: The research question was to identify and prioritize eligible patients for a medication review and to provide evidence-based criteria for patient selection. Acceptance of the prescribing general practitioner to implement pharmaceutical recommendations was measured and factors influencing physicians' acceptance were explored to obtain an impression on the extent of collaboration in medication review in an ambulatory care setting.

Methods: Based on data of a cluster-randomized controlled study (WestGem-study), the correlation between patient parameters and the individual performance in a medication review was calculated in a multiple logistic regression model. Physician's acceptance of the suggested intervention was assessed using feedback forms. Influential factors were analyzed.

Results: The number of drugs in use (p = 0.001), discrepancies between prescribed and used medicines (p = 0.014), the baseline Medication Appropriateness Index score (p<0.001) and the duration of the intervention (p = 0.006) could be identified as influential factors for a major benefit from a medication review, whereas morbidity (p>0.05) and a low kidney function (p>0.05) do not predetermine the outcome. Longitudinal patient care with repeated reviews showed higher interprofessional acceptance and superior patient benefit. A total of 54.9% of the recommendations in a medication review on drug therapy were accepted for implementation.

Conclusions: The number of drugs in use and medication reconciliation could be a first rational step in patient selection for a medication review. Most elderly, multimorbid patients with polymedication experience a similar chance of receiving a benefit from a medication review. Longitudinal patient care should be preferred over confined medication reviews. The acceptance of medication reviews by physicians supports further implementation into health care systems.

Trial registration: ISRCTN ISRCTN41595373.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Ambulatory Care
  • Cardiovascular Diseases / drug therapy*
  • Cardiovascular Diseases / epidemiology
  • Drug Interactions*
  • Female
  • Geriatrics
  • Humans
  • Male
  • Medical Records
  • Medication Therapy Management*
  • Pharmacists
  • Physicians

Grants and funding

The WestGem-study was funded by the European Union and the state of North Rhine-Westphalia (Ziel 2, IuK & Gender Med.NRW, GW 2076). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Participating study pharmacists were employed by a pharmacy called Elefanten-Apotheke, Steinfurt, Germany during the study and received the funding as a salary. They also received funded research materials from the pharmacy. The pharmacy played no active role as all pharmacists were blinded to the patients and physicians. The pharmacy had no commercial interest in the findings of the study. The funder provided support in the form of salaries for authors [CJ, ML, DMK, KR, IW], but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.