title: Effects of a three party healthcare network on the incidence levels of drug related problems.
abstract: BACKGROUND
  Drug related problems (DRPs) are impairing patients' health and cause high costs. Neither delegation of home medication review nor regular pharmaceutical care are common in Germany.
  
  
  OBJECTIVE
  We aimed to reduce several DRP by the implementation of a three party healthcare team [AGnES-practice assistant, pharmacist, general practitioner (GP)] and adherence supporting strategies (using a medication reminder chart, medication compliance aid).
  
  
  METHODS
  The setting was ambulatory primary healthcare in German rural areas with a cohort of home-dwelling, elderly, mostly multimorbid patients with limited mobility (study period: 06/2006-12/2008).
  
  
  METHODS
  We conducted a prospective non-randomized implementation cohort study with home medication review (home medication review module; mean participation time: 9 months). Data collection was delegated to additionally qualified AGnES-practice assistants (AGnES: GP-supporting, community-based, e-health-assisted systemic intervention). The intervention comprised pharmaceutical care by the local pharmacy in addition to medical interventions by the GP. 408 patients (mean age: women: 80.7 years; men: 75.3 years) received both pharmaceutical care and at least one follow-up visit.
  
  
  METHODS
  Outcome measurements comprised self-reported DRPs, objectively evaluated DRP, and prevalence of adherence supporting strategies.
  
  
  RESULTS
  The three party healthcare team approach reduced self-reported forgetfulness (7.7-3.2 %; p = 0.001), the proportion of patients with intermittent drug intake (5.3-1.3 %; p < 0.001), and the proportion of patients with potentially clinical relevant drug-drug interaction (61.6-51.2 %; p < 0.001). Self-reported adverse drug reactions decreased non-significantly (5.4-4.6 %; p = 0.564; all tests χ²-McNemar). The median number of active substances taken was reduced from 8 to 7 (p < 0.001; Wilcoxon signed rank test). The proportions of patients using medication charts and compliance aids increased significantly (75.2-90.3 %; p < 0.001) and (70.0-80.1 %; p > 0.001), respectively.
  
  
  CONCLUSIONS
  This is the first study evaluating effects of a three party team on DRPs in a primary healthcare setting in Germany. This approach led to reduction in the occurrence of several DRPs and improved adherence supporting strategies. However, the study is a pre-post analysis, and had no control group.
authors.affiliation: German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Ellernholzstreet 1/2, 17487, Greifswald, Germany, Thomas.fiss@uni-greifswald.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fiß
authors.forename: Claudia
authors.initials: C
authors.lastname: Meinke-Franze
authors.forename: Neeltje
authors.initials: N
authors.lastname: van den Berg
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hoffmann
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D019058:Community Networks; D015897:Comorbidity; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000451:nursing / Q000517:prevention & control*; D057286:Electronic Health Records; D005260:Female; D058005:General Practitioners; D005858:Germany / Q000453:epidemiology; D006299:Health Services for the Aged; D006801:Humans; D015994:Incidence; D008297:Male; D055118:Medication Adherence; D059065:Medication Reconciliation; D064691:Nurses, Community Health / Q000193:education; D010595:Pharmacists; D010823:Physician Assistants / Q000193:education; D011446:Prospective Studies; D012423:Rural Health; D000078329:Workforce