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Topics: 02.5 HF-REF - Therapie - medikamentös
13.1 Versorgungsforschung

18.01.2017 09:14

Evaluating Internal Medicine Patients’ Comprehensibility of a Standardized Medication Plan (§ 31a SGB V)
L. Botermann1, K. Monzel2, K. Krueger1, C. Eickhoff1, A. Wachter2, C. Kloft3, U. Laufs2, M. Schulz1
1Geschäftsbereich Arzneimittel, ABDA - Bundesvereinigung Deutscher Apothekerverbände, Berlin; 2Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar; 3Abt. Klinische Pharmazie & Biochemie, Freie Universität Berlin, Institut für Pharmazie, Berlin;

Purpose: A standardized medication plan (MP) was recently enacted into German Law (§ 31a SGB V). It has never been studied if patients with chronic diseases requiring polymedication understand the standardized MP and can transfer the given information into practice.

Patients and methods: 140 patients who took at least five medicines regularly were prospectively included in a cross-sectional study: 40 general internal medicine (GIM) patients, 50 patients with the primary diagnosis chronic heart failure (CHF), and 50 with diabetes mellitus type 2 (DMT2). We performed a structured test-scenario studying the handling of a provided MP then evaluated the execution of the information on the MP by filling pill boxes and requested patients’ opinion. An established weighted scoring system, the “Evaluation Tool to test the handling of the Medication Plan” (ET-MP) was applied to quantitate the ability of the patients to handle the MP. In addition for CHF and DMT2 patients, signs of depression, cognitive function and self-care behavior in chronic heart failure were characterized using the PHQ-9, Mini-Cog, and G9-EHFScB-9 questionnaires, respectively.

Results: Only 37% (n=52) of the patients were able to handle the medication plan without difficulties (ET-MP score > 90%). The mean ET-MP score was 78 ± 56% (GIM: 86 ± 19%, CHF: 78 ± 23% (p=.16 vs. GIM), DMT2: 68 ± 30% (p=.13 vs. CHF; p=.006 vs. GIM)). Understanding of the MP was better in patients aged < 70 years (83 ± 22%) compared to ≥ 70 years (71 ± 28%, p = .004). Patients with more or equal than 10 years of education achieved higher ET-MP results (88 ± 19%) than patients with < 10 years of education (67 ± 27%, p < .0001). Patients with signs of cognitive impairment exhibited significantly lower ET-MP scores (61 ± 28%) than patients without cognitive impairment (80 ± 24%, p < .0001). There were no significant correlations of the ET-MP score with the number of daily medications, living situation, sex, the Charlson Comorbidity Index, the PHQ-9 Score, usage of a dosing aid or possession of a medication list.

Conclusion: Many internal medicine patients with polymedication show problems using the standardized medication plan. Higher age, lower education and cognitive impairment identify patients that require additional assistance.