General practitioners' views on polypharmacy and its consequences for patient health care.
BACKGROUND
Multimorbidity is defined as suffering from coexistent chronic conditions. Multimorbid patients demand highly complex patient-centered care which often includes polypharmacy, taking an average of six different drugs per day. Adverse drug reactions, adverse drug events and medication errors are all potential consequences of polypharmacy. Our study aims to detect the status quo of the health care situation in Saxony's general practices for multimorbid patients receiving multiple medications. We will identify the most common clinical profiles as well as documented adverse drug events and reactions that occur during the treatment of patients receiving multiple medications. We will focus on exploring the motives of general practitioners for the prescription of selected drugs in individual cases where there is evidence of potential drug-drug-interactions and potentially inappropriate medications in elderly patients. Furthermore, the study will explore general practitioners' opinions on delegation of skills to other health professions to support medical care and monitoring of patients receiving multiple medications.


METHODS
This is a retrospective cross sectional study using mixed methods. Socio-demographic data as well as diagnoses, medication regimens and clinically important events will be analyzed retrospectively using general practitioners documentation in patients' records. Based on these data, short vignettes will be generated and discussed by general practitioners in qualitative telephone interviews.


CONCLUSIONS
To be able to improve outpatient health care management for patients receiving multiple medications, the current status quo of care, risk factors for deficient treatment and characteristics of concerned patients must be investigated. Furthermore, it is necessary to understand the physicians' decision making process regarding treatment.
Department of General Practice / Medical Clinic III, Dresden Medical School, University of Technology, Fetscherstr, 74, Dresden 01307, Germany.
Juliane
J
Köberlein
Mandy
M
Gottschall
Kathrin
K
Czarnecki
Alexander
A
Thomas
Antje
A
Bergmann
Karen
K
Voigt
D000368:Aged; D002908:Chronic Disease / Q000188:drug therapy*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D058005:General Practitioners / Q000523:psychology* / Q000592:standards; D005858:Germany; D006300:Health Services Misuse / Q000517:prevention & control; D006299:Health Services for the Aged / Q000592:standards; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration / Q000592:standards*; D019338:Polypharmacy; D010818:Practice Patterns, Physicians' / Q000592:standards; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014505:Urban Population