Multimedication Guidelines: Assessment of the Size of the Target Group for Medication Review and Description of the Frequency of Their Potential Drug Safety Problems with Routine Data

Abstract

(1) Background: About 10 years ago, several guidelines for the better management of patients with polypharmacy were issued. A central issue is the definition of the target group. The primary aim of this study is therefore to assess the size of the target group, applying the criteria of the German guidelines. A further aim is to describe the frequency of occurrence of medication safety issues for patients of the target group. (2) Methods: The study is based on administrative data of one large statutory health insurer in Germany (n = 9,012,523). (3) Results: The criteria of multimorbidity (at least three chronic diseases) and utilization of five or more concurrent drugs over at least 91 days is fulfilled by 14.1% of the insured patients, or almost 1.3 million persons. About 5% of this multimorbid and poly-medicated population fulfilled at least three of out of five additional occasion-related criteria. Medication safety issues occur frequently: treatment prevalence with potentially inadequate medication, QT-drugs, benzodiazepine or Z-drugs and proton pump inhibitors was 30.4%, 28.9%, 11.1% and 52.4%, respectively. (4) Conclusions: The analysis shows the scope of patients eligible for a structured medication review and demonstrates the relevance for counselling based on the high percentage potentially at risk due to medication therapy safety problems.

Stakeholder Perspectives on the Development and Implementation of a Polypharmacy Management Program in Germany: Results of a Qualitative Study

“…Some participants suggested selecting the target group based on a defined minimum number of chronic conditions or medications by, for example, using routine data or data from medical records. An analysis conducted as part of the EVITA study and based on routine data showed that 31.7% of those aged 65–79, and 48.4% of patients aged >79 years, fulfilled the criteria of ≥3 chronic conditions and ≥5 chronic medications [ 11 ]. While these numerical inclusion criteria may be easy to implement, the high percentage of potentially eligible patients limits feasibility in clinical practice.…”

“…A combination of several inclusion criteria may further help in the selection of a target group. For example, by adding the criterion of ≥2 hospital admissions within the last year, it was possible to reduce the target group to 16.4 and 21.5% (age groups: 65–79 and >79 years, respectively) [ 11 ]. Other inclusion criteria identified in a case study on European polypharmacy management initiatives included, for example, having complex care needs, admission to an acute geriatric or intermediate care unit, and ≥10 medications [ 19 ].…”

“…The EVITA study (Evidence-based Polypharmacy Program with Implementation in Health Care) investigated, how a comprehensive polypharmacy management program (PMP) could be developed and implemented in Germany. In the multicenter project, we examined systematic reviews (e.g., of multimorbidity and polypharmacy guidelines [ 9 ]), performed an evidence-based update and upgrade of the existing German polypharmacy guideline [ 10 ], analyzed routine data [ 11 ], and qualitatively analyzed stakeholders’ perspectives. The aim of the latter, the results of which are presented here, was to investigate stakeholders’ views on the development and implementation of a structured program for the management of patients with polypharmacy in Germany.…”

Multimedikation

“…1,3 von 9 Mio. BARMER-Versicherten finden (Lappe et al 2022). Von Multimedikation sind dabei in besonderem Maße Ältere und Hochaltrige betroffen.…”

“…auf fast jede zweite Person zu -jeder zehnten bis zwanzigsten Person dieser Altersgruppe werden sogar zehn oder mehr Medikamente dauerhaft verordnet (Lappe et al 2022).…”