title: Priority Setting and Influential Factors on Acceptance of Pharmaceutical Recommendations in Collaborative Medication Reviews in an Ambulatory Care Setting - Analysis of a Cluster Randomized Controlled Trial (WestGem-Study).
abstract: BACKGROUND
  Medication reviews are recognized services to increase quality of therapy and reduce medication risks. The selection of eligible patients with potential to receive a major benefit is based on assumptions rather than on factual data. Acceptance of interprofessional collaboration is crucial to increase the quality of medication therapy.
  
  
  OBJECTIVE
  The research question was to identify and prioritize eligible patients for a medication review and to provide evidence-based criteria for patient selection. Acceptance of the prescribing general practitioner to implement pharmaceutical recommendations was measured and factors influencing physicians' acceptance were explored to obtain an impression on the extent of collaboration in medication review in an ambulatory care setting.
  
  
  METHODS
  Based on data of a cluster-randomized controlled study (WestGem-study), the correlation between patient parameters and the individual performance in a medication review was calculated in a multiple logistic regression model. Physician's acceptance of the suggested intervention was assessed using feedback forms. Influential factors were analyzed.
  
  
  RESULTS
  The number of drugs in use (p = 0.001), discrepancies between prescribed and used medicines (p = 0.014), the baseline Medication Appropriateness Index score (p<0.001) and the duration of the intervention (p = 0.006) could be identified as influential factors for a major benefit from a medication review, whereas morbidity (p>0.05) and a low kidney function (p>0.05) do not predetermine the outcome. Longitudinal patient care with repeated reviews showed higher interprofessional acceptance and superior patient benefit. A total of 54.9% of the recommendations in a medication review on drug therapy were accepted for implementation.
  
  
  CONCLUSIONS
  The number of drugs in use and medication reconciliation could be a first rational step in patient selection for a medication review. Most elderly, multimorbid patients with polymedication experience a similar chance of receiving a benefit from a medication review. Longitudinal patient care should be preferred over confined medication reviews. The acceptance of medication reviews by physicians supports further implementation into health care systems.
  
  
  BACKGROUND
  ISRCTN ISRCTN41595373.
authors.affiliation: Clinical Pharmacy, Institute of Pharmacy, University of Bonn, Bonn, Germany.|Elefanten-Apotheke, Steinfurt, Germany.
authors.forename: Olaf
authors.initials: O
authors.lastname: Rose
authors.affiliation: Department of Social Sciences, University of Applied Science Muenster, Muenster, Germany.
authors.forename: Hugo
authors.initials: H
authors.lastname: Mennemann
authors.affiliation: Elefanten-Apotheke, Steinfurt, Germany.
authors.forename: Carina
authors.initials: C
authors.lastname: John
authors.affiliation: Elefanten-Apotheke, Steinfurt, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Lautenschläger
authors.affiliation: Elefanten-Apotheke, Steinfurt, Germany.
authors.forename: Damaris
authors.initials: D
authors.lastname: Mertens-Keller
authors.affiliation: Elefanten-Apotheke, Steinfurt, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Richling
authors.affiliation: Department of Pharmaceutical and Medicinal Chemistry, Clinical Pharmacy, Westfaelische Wilhelms-University, Muenster, Germany.|Elefanten-Apotheke, Steinfurt, Germany.
authors.forename: Isabel
authors.initials: I
authors.lastname: Waltering
authors.affiliation: Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Koeln, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Hamacher
authors.affiliation: Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Koeln, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Felsch
authors.affiliation: Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Koeln, Germany.
authors.forename: Lena
authors.initials: L
authors.lastname: Herich
authors.affiliation: Department of Health Care Management and Public Health, Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Czarnecki
authors.affiliation: Department of Health Care Management and Public Health, Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany.
authors.forename: Corinna
authors.initials: C
authors.lastname: Schaffert
authors.affiliation: Clinical Pharmacy, Institute of Pharmacy, University of Bonn, Bonn, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Jaehde
authors.affiliation: Department of Health Care Management and Public Health, Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany.
authors.forename: Juliane
authors.initials: J
authors.lastname: Köberlein-Neu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000453:epidemiology; D004347:Drug Interactions; D005260:Female; D005853:Geriatrics; D006801:Humans; D008297:Male; D008499:Medical Records; D054539:Medication Therapy Management; D010595:Pharmacists; D010820:Physicians