Reducing cardiovascular medication complexity in a German university hospital: effects of a structured pharmaceutical management intervention on adherence
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Reducing cardiovascular medication complexity in a German university hospital: effects of a structured pharmaceutical management intervention on adherence. / Stange, Dorit; Kriston, Levente; von Wolff, Alessa; Baehr, Michael; Dartsch, Dorothee C.
In: J MANAGE CARE PHARM, Vol. 19, No. 5, 01.06.2013, p. 396-407.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Reducing cardiovascular medication complexity in a German university hospital: effects of a structured pharmaceutical management intervention on adherence
AU - Stange, Dorit
AU - Kriston, Levente
AU - von Wolff, Alessa
AU - Baehr, Michael
AU - Dartsch, Dorothee C
PY - 2013/6/1
Y1 - 2013/6/1
N2 - BACKGROUND: Patient adherence is necessary for successful medication therapy. However, highly complex medication regimens may lead to poor adherence, which decreases the effectiveness of treatment and often results in treatment failure, excessive morbidity and mortality, and higher costs. OBJECTIVE: To examine whether patient adherence can be increased indirectly through reducing medication complexity by (a) pharmaceutical counseling of hospital medical staff and (b) additional information in the discharge letter for the primary care provider (PCP) about the simplified discharge medication. METHODS: At the Medical Center Hamburg-Eppendorf, a tertiary care university hospital in Germany, 240 chronically ill inpatients with hypertension, diabetes, and/or dyslipidemia were enrolled in this prospective, semirandomized study. For the intervention group, hospital doctors were counseled by a clinical pharmacist on feasible simplifications of cardiovascular and antidiabetic medications. In 1 randomized subgroup, the PCP received additional explanatory information in the discharge letter. Adherence (self-reporting using the Medication Adherence Rating Scale [MARS-D]) and medication complexity (using the Medication Regimen Complexity Index [MRCI-D]) were recorded at admission to the hospital, discharge from the hospital, and 6 weeks after discharge. Patient quality of life (QoL) and satisfaction with information about medications were assessed at admission and after discharge. RESULTS: At discharge, the medication regimen in the intervention group was significantly less complex than in the comparison group. Yet, 6 weeks after discharge, the complexity of the outpatient medication had increased to values similar to the comparison group, unless the PCP received additional information in the discharge letter. Propensity adjusted complete adherence rates at discharge were slightly, but not significantly, higher in the intervention group than in the comparison group. Within the intervention group, complete adherence was more frequent in the subgroup with additional information for the PCP. Patient QoL and satisfaction with information were comparable in both groups. CONCLUSION: The complexity of cardiovascular and antidiabetic hospital medications can be reduced by counseling the hospital doctors. However, for a sustainable simplification of outpatient medication, the PCPs must receive explicit information about the modifications. Patient adherence was not significantly influenced by this intervention. To verify these results, further research with objective measures of adherence and in patients with other diseases is needed.
AB - BACKGROUND: Patient adherence is necessary for successful medication therapy. However, highly complex medication regimens may lead to poor adherence, which decreases the effectiveness of treatment and often results in treatment failure, excessive morbidity and mortality, and higher costs. OBJECTIVE: To examine whether patient adherence can be increased indirectly through reducing medication complexity by (a) pharmaceutical counseling of hospital medical staff and (b) additional information in the discharge letter for the primary care provider (PCP) about the simplified discharge medication. METHODS: At the Medical Center Hamburg-Eppendorf, a tertiary care university hospital in Germany, 240 chronically ill inpatients with hypertension, diabetes, and/or dyslipidemia were enrolled in this prospective, semirandomized study. For the intervention group, hospital doctors were counseled by a clinical pharmacist on feasible simplifications of cardiovascular and antidiabetic medications. In 1 randomized subgroup, the PCP received additional explanatory information in the discharge letter. Adherence (self-reporting using the Medication Adherence Rating Scale [MARS-D]) and medication complexity (using the Medication Regimen Complexity Index [MRCI-D]) were recorded at admission to the hospital, discharge from the hospital, and 6 weeks after discharge. Patient quality of life (QoL) and satisfaction with information about medications were assessed at admission and after discharge. RESULTS: At discharge, the medication regimen in the intervention group was significantly less complex than in the comparison group. Yet, 6 weeks after discharge, the complexity of the outpatient medication had increased to values similar to the comparison group, unless the PCP received additional information in the discharge letter. Propensity adjusted complete adherence rates at discharge were slightly, but not significantly, higher in the intervention group than in the comparison group. Within the intervention group, complete adherence was more frequent in the subgroup with additional information for the PCP. Patient QoL and satisfaction with information were comparable in both groups. CONCLUSION: The complexity of cardiovascular and antidiabetic hospital medications can be reduced by counseling the hospital doctors. However, for a sustainable simplification of outpatient medication, the PCPs must receive explicit information about the modifications. Patient adherence was not significantly influenced by this intervention. To verify these results, further research with objective measures of adherence and in patients with other diseases is needed.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Cardiovascular Agents
KW - Diabetes Mellitus
KW - Dyslipidemias
KW - Female
KW - Follow-Up Studies
KW - Germany
KW - Hospitals, University
KW - Humans
KW - Hypertension
KW - Hypoglycemic Agents
KW - Male
KW - Medical Staff, Hospital
KW - Medication Adherence
KW - Middle Aged
KW - Patient Discharge
KW - Patient Satisfaction
KW - Pharmacists
KW - Pharmacy Service, Hospital
KW - Professional Role
KW - Prospective Studies
KW - Quality of Life
KW - Young Adult
M3 - SCORING: Journal article
C2 - 23697477
VL - 19
SP - 396
EP - 407
JO - J MANAGE CARE PHARM
JF - J MANAGE CARE PHARM
SN - 1083-4087
IS - 5
ER -