title: [GP medication prioritisation in older patients with multiple comorbidities recently discharged from hospital: a case-based bottom-up approach].
abstract: BACKGROUND
  After the hospital discharge of older patients with multiple morbidities, GPs are often faced with the task of prioritising the patients' drug regimens so as to reduce the risk of overmedication.
  
  
  OBJECTIVE
  How do GPs prioritise such medications in multimorbid elderly patients at the transition between inpatient and home care? The experience by the GPs is documented in typical case vignettes.
  
  
  METHODS
  44 GPs in Sachsen-Anhalt were recruited--they were engaged in focus group discussions and interviewed using semi-standardised questionnaires. Typical case vignettes were developed, relevant to the everyday care that elderly patients would typically receive from their GPs with respect to their drug optimisation.
  
  
  RESULTS
  According to the results of the focus groups, the following issues affect GPs' decisions: drug and patient safety, their own competence in the health system, patient health literacy, evidence base, communication between secondary and primary care (and their respective influences on each other). When considering individual cases, patient safety, patient wishes, and quality of life were central. This is demonstrated by the drug dispositions of one exemplary case vignette.
  
  
  CONCLUSIONS
  GPs do prioritise drug regimens with rational criteria. Initial problem delineation, process documentation and the design of a transferable product are interlinking steps in the development of case vignettes. Care issues of drug therapy in elderly patients with multiple morbidities should be investigated further with larger representative samples in order to clarify whether the criteria used here are applied contextually or consistently. Embedding case vignettes into further education concepts is also likely to be useful.
authors.affiliation: Institut für Allgemeinmedizin, Otto-von-Guericke-Universität Magdeburg, Magdeburg.
authors.forename: M L H
authors.initials: ML
authors.lastname: Herrmann
authors.affiliation: Institut für Allgemeinmedizin, Otto-von-Guericke-Universität Magdeburg, Magdeburg.
authors.forename: G H
authors.initials: GH
authors.lastname: von Waldegg
authors.affiliation: Institut für Allgemeinmedizin, Otto-von-Guericke-Universität Magdeburg, Magdeburg.
authors.forename: M
authors.initials: M
authors.lastname: Kip
authors.affiliation: Soziologische Beratung und Forschung, Magdeburg.
authors.forename: B
authors.initials: B
authors.lastname: Lehmann
authors.affiliation: Allgemeinmedizinische Praxis, Halberstadt.
authors.forename: S
authors.initials: S
authors.lastname: Andrusch
authors.affiliation: Allgemeinmedizinische Praxis, Derenburg.
authors.forename: H
authors.initials: H
authors.lastname: Straub
authors.affiliation: Institut für Sozialmedizin und Gesundheitsökonomie, Otto-von-Guericke-Universität Magdeburg, Magdeburg.
authors.forename: B-P
authors.initials: BP
authors.lastname: Robra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D003625:Data Collection; D003657:Decision Making; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D005858:Germany; D015276:Health Care Rationing / Q000379:methods / Q000706:statistics & numerical data*; D006292:Health Priorities / Q000706:statistics & numerical data*; D006300:Health Services Misuse / Q000517:prevention & control*; D006299:Health Services for the Aged / Q000706:statistics & numerical data; D006699:Home Care Services; D006801:Humans; D008297:Male; D054539:Medication Therapy Management / Q000706:statistics & numerical data; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data; D055656:Prescriptions / Q000706:statistics & numerical data*