Medication complexity, prescription behaviour and patient adherence at the interface between ambulatory and stationary medical care

Stange, Dorit; Kriston, Levente; Wolff, Alessa von; Baehr, Michael; Dartsch, Dorothee C.

doi:10.1007/s00228-012-1342-2

Cited by 14 publications

(21 citation statements)

References 37 publications

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“…The MRCI has been used to compute regimen complexity in inpatient and outpatient settings among people with diabetes [11,12], cardiovascular disease [13], depression [14], multimorbidity [15] and those receiving nocturnal home haemodialysis [16]. Studies have been conducted in hospital inpatients [2,6,8,17,18], and in nursing homes [19]. Regimen complexity has also been computed utilising electronic medical records from different healthcare providers in the USA [4,20,21].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with medication regimen complexity in older people: a cross-sectional population-based study

Wimmer

Johnell

Fastbom

et al. 2015

Eur J Clin Pharmacol

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Older people with probable difficulties managing complex regimens, including those with impaired dexterity and living in institutional settings, had the most complex medication regimens even after adjusting for receipt of help to sort medications. The strong correlation between regimen complexity and number of medications suggests that clinicians could use a person's number of medications to target interventions to reduce complexity.

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Section: Introductionmentioning

confidence: 99%

Factors associated with medication regimen complexity in older people: a cross-sectional population-based study

Wimmer

Johnell

Fastbom

et al. 2015

Eur J Clin Pharmacol

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“…29 Adherence increased during the hospital stay, where the supply of medications was more controlled, the intake was supervised, and the day was scheduled with predetermined mealtimes. Still, adherence did not reach 100% in the hospital.…”

Section: ■■ Discussionmentioning

confidence: 99%

“…So, further research is needed in this area because this is a highly complex issue with diverging views. 29 In earlier studies, correlation between medication complexity and health-related QoL has been a controversial subject. While Cardone et al (2011) did not find a significant relationship between the medication regimen complexity and SF-36 in the setting of nocturnal home dialysis patients, 55 a higher pill burden was associated with lower QoL for patients with traditional in-center hemo-dialysis.…”

Section: ■■ Discussionmentioning

confidence: 99%

“…28,29 Adherence was significantly increased during the hospital stay (presumably because of a more controlled medication supply and administration) but returned to baseline values after discharge. 29 Concerning changes in therapy, Himmel et al (1996; found that about 50% of the medications used for chronic treatment were changed during hospitalization. 30,31 Similar results were obtained by Viktil et al (2012), and a marked influence of hospitalization on changes in drug therapy in ambulatory care was shown.…”

Section: ■■ Methods Patients and Study Designmentioning

confidence: 99%

“…The PCPs were further asked about their reasons for acceptance or modifications of the discharge medications. 29 Adherence to prescribed drug treatment was measured with pseudonymous questionnaires for patient self-reporting (Medication Adherence Rating Scale [MARS-D]). 16,38 Because of the expected strong deviation from a normal distribution as a consequence of strong ceiling effects, sum scores were dichotomized with a cut-off point at 25 as chosen in a previous Reducing Cardiovascular Medication Complexity in a German University Hospital: Effects of a Structured Pharmaceutical Management Intervention on Adherence study.…”

Section: Data Collection and Measuresmentioning

confidence: 99%

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Reducing Cardiovascular Medication Complexity in a German University Hospital: Effects of a Structured Pharmaceutical Management Intervention on Adherence

Stange

Kriston²,

von-Wolff³

et al. 2013

JMCP

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Verordnungsverhalten von bayerischen Hausärzt*innen an der stationär-ambulanten Schnittstelle vor dem Hintergrund der Bayerischen Wirkstoffvereinbarung – Qualitative Ergebnisse der WirtMed-Studie

Zeschick

Gollnick

Muth

et al. 2022

Bundesgesundheitsbl

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Zusammenfassung Hintergrund und Ziel Zur transparenten Steuerung der Arzneimittelausgaben im Rahmen des Wirtschaftlichkeitsgebots (§ 12 Fünftes Buch Sozialgesetzbuch (SGB V)) hat die Kassenärztliche Vereinigung Bayerns im Jahr 2014 die Wirkstoffvereinbarung (WSV) eingeführt. Diese hat die Richtgrößensystematik abgelöst. Mit Bezug auf die Rolle der WSV werden im Artikel die Gründe der Hausärzt*innen (HÄ) für oder gegen eine Weiterverordnung von Arzneimitteln aus dem Krankenhaus beschrieben. Material und Methode In einem qualitativen Studiendesign wurden im Zeitraum 11/2019 bis 03/2020 mit bayerischen HÄ Einzelinterviews (n = 18) und 2 Fokusgruppen (n = 10) durchgeführt und nach der qualitativen Inhaltsanalyse ausgewertet. Ergebnisse Mit der Einführung der WSV nahmen die Regresssorgen der HÄ insgesamt ab. Große Bedeutung bei Verordnungen haben – vor der Wirtschaftlichkeit – die patient*innenorientierte Versorgung und fachliche Richtigkeit von Therapieentscheidungen. Mit der Entlassmedikation ergeben sich wirtschaftliche Herausforderungen, besonders mit dem Leitsubstanzziel der oralen Antikoagulation, den Generikazielen bei Antidiabetika und bei Therapeutika für das Herz-Kreislauf-System. Allgemein kritisiert werden Rabattverträge, die oft zu Umstellungen von Arzneimitteln führen. Vereinzelt wird von einer „Vormachtstellung“ der Klinikärzt*innen berichtet, die dem hausärztlichen wirtschaftlichen Handeln entgegenstehen. Es fehlt laut HÄ eine sektorenübergreifende Kostenverantwortung. Diskussion Ein reibungsloser Schnittstellenübergang ist aus Sicht der HÄ trotz des Rahmenvertrags Entlassmanagement und der neuen Steuerungssystematik der WSV im ambulanten Sektor noch nicht vorhanden. Für eine wirtschaftliche Arzneimittelversorgung bedarf es weiterhin einer sektorenübergreifenden, aber auch bundesländerübergreifenden politischen Diskussion.

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Medication complexity, prescription behaviour and patient adherence at the interface between ambulatory and stationary medical care

Cited by 14 publications

References 37 publications

Factors associated with medication regimen complexity in older people: a cross-sectional population-based study

Factors associated with medication regimen complexity in older people: a cross-sectional population-based study

Reducing Cardiovascular Medication Complexity in a German University Hospital: Effects of a Structured Pharmaceutical Management Intervention on Adherence

Verordnungsverhalten von bayerischen Hausärzt*innen an der stationär-ambulanten Schnittstelle vor dem Hintergrund der Bayerischen Wirkstoffvereinbarung – Qualitative Ergebnisse der WirtMed-Studie

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