[Potential Benchmarks for Successful Interdisciplinary Collaboration Projects in Germany: A Systematic Review].

AIM OF THE STUDY:Collaboration between general practitioners and community pharmacists is essential to ensure safe and effective patient care. However, collaboration in primary care is not standardized and varies greatly. This review aims to highlight projects about professional collaboration in ambulatory care in Germany and identifies promising approaches and successful benchmarks that should be considered for future projects. METHODS:A systematic literature search was performed based on the PRISMA guidelines to identify articles focusing on professional collaboration between general practitioners and pharmacists. RESULTS:A total of 542 articles were retrieved. Six potential premises for successful cooperation projects were identified: GP and CP knowing each other (I), involvement of both health care providers in the project planning (II), sharing of experience or concerns during regular joint meetings enabling continuing evaluation and adaption (III), ensuring (technical) feasibility (IV), particularly by providing incentives (V), and by integrating these projects into existing health care structures (VI). CONCLUSION:Only few studies have been published in scientific journals. There was no standardized assessment of how the participants perceived their collaboration and how it facilitates their daily work, even when the study aimed to evaluate GP-CP collaboration. Successful cooperation between GP and CP in daily routine care was often characterized by personal contact and longtime relationships. Therefore, collaborative teaching sessions at university might establish sympathy and mutual understanding right from the beginning. There is a strong need to establish standardized tools to evaluate collaboration in future projects and to enable comparability of different studies

How to meet patients' individual needs for drug information - a scoping review

Marcel KP Kusch,1,2 Walter E Haefeli,1,2 Hanna M Seidling1,2 1Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, 69120 Heidelberg, Baden-Wurttemberg, Germany; 2Cooperation Unit Clinical Pharmacy, University of Heidelberg, 69120 Heidelberg, Baden-Wurttemberg, Germany Purpose: The aim of this study was to 1) describe drug information desired by patients and 2) analyze how such information could be customized to be presented to patients according to their individual information needs.Materials and methods: We performed a scoping literature search and identified relevant drug information topics by assessing and clustering 1) studies analyzing patients’ enquiries to drug information hotlines and services, and 2) qualitative studies evaluating patient drug information needs. For the two most frequently mentioned topics, we further analyzed which components (ie, information domains) the topics contained and examined patients’ and health care professionals’ (HCPs) views on these components.Results: Of 27 identified drug information topics in the literature search, patients most frequently requested information on adverse drug reactions (ADRs) and drug–drug interactions (DDIs). Hypothetically, those topics are composed of seven distinct information domains each (eg, ADR and DDI classification by frequency, severity, or onset; information on management strategies, monitoring, and prevention strategies). Patients’ and HCPs’ appraisal concerning the information content of these domains varies greatly and is even lacking sometimes.Conclusion: Patients particularly request information on ADRs and DDIs. Approaches to customize such information are sparse. The identified information domains of each topic could be used to structure corresponding drug information and to thus facilitate customization to individual information needs. Keywords: medication information, information needs, customization, adverse drug reactions, side effects, drug–drug interactions &nbsp

Do we prescribe what patients prefer? Pilot study to assess patient preferences for medication regimen characteristics

Diana Witticke,1,2 Hanna Marita Seidling,1,2 Hans-Dieter Klimm,3 Walter Emil Haefeli1,21Department of Clinical Pharmacology and Pharmacoepidemiology, 2Cooperation Unit Clinical Pharmacy, 3Department of General Practice and Health Service Research, University of Heidelberg, Heidelberg, GermanyBackground: The aim of this pilot study was to evaluate patients' self-reported attitudes towards medication-related factors known to impair adherence and to assess their prevalence in ambulatory care as an essential prerequisite to improve patient adherence.Methods: We conducted a face-to-face interview with 110 primary care patients maintained on at least one drug. For each drug, the patient was asked to specify medication-related factors of interest, ie, dosage form, dosage interval, required relationship with food intake, and the planned time of day for intake, and to rate the individual relevance of each prevalent parameter on a three-point Likert scale (discriminating between prefer, neutral, and dislike).Results: Tablets with a once-daily dosage frequency were the most preferred dosage form, with a high prevalence in the ambulatory setting. Drug intake in the morning and evening were most preferred, and drug intake at noon was least preferred, but also had a low prevalence in contrast with drug intake independent of meals that was most preferred. Interestingly, only one quarter (26.4%) of all the patients were able to indicate clear preferences or dislikes.Conclusion: When patients are asked to specify their preferences for relevant medication regimen characteristics, they clearly indicated regimens that have been associated with better adherence in earlier studies. Therefore, our results suggest that adaptation of drug regimens to individual preferences might be a promising strategy to improve adherence. Because the German health care system may differ from other systems in relevant aspects, our findings should be confirmed by evaluation of patient preferences in other health care systems. Once generalizability of the study results is shown, these findings could be a promising basis upon which to promote patient adherence right from the beginning of drug therapy.Keywords: patient perception, medication regimen complexity, adherenc

Patients' perception on generating medication plans in an interprofessional medication management program: a mixed-methods study.

A medication plan (MP) provides an overview of a patient's entire medication. In the interprofessional medication management program ARMIN (ARzneiMittelINitiative Sachsen-Thueringen), MPs are jointly generated by general practitioners (GPs) and community pharmacists (CPs). We aimed to assess patients' initial acceptance of the service, how they use the printed MP, and whether they perceived a benefit from it. This was evaluated with mixed-methods: a cross sectional written (quantitative) survey followed by semi-structured (qualitative) interviews. The data were analysed separately and compared. Qualitative data were analysed by thematic analysis. For the survey, 103 patients (mean 73 years) were involved. Benefits indicated were: improved communication between GPs and CPs, safer handling of the medication, and increased knowledge on dosages and indications. Ninety-six percent of the patients used their MP, 51% regularly. Regular use was significantly associated with older age, higher number of drugs, and need for assistance with the medication. Ten patients were interviewed. Results from interviews agreed with the results from the survey but revealed some additional aspects (e.g., patients reported an increased feeling of safety). Health-care professionals should consider providing MPs for their patients. This interprofessional cooperation also meets patient's need for safety in health issues

Factors associated with medication information in diabetes care: differences in perceptions between patients and health care professionals

Gerda Längst,1 Hanna Marita Seidling,2,3 Marion Stützle,2,3 Dominik Ose,1 Ines Baudendistel,1 Joachim Szecsenyi,1 Michel Wensing,1,4 Cornelia Mahler1 1Department of General Practice and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany; 2Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg, Germany; 3Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany; 4Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare, Nijmegen, the Netherlands Purpose: This qualitative study in patients with type 2 diabetes and health care professionals (HCPs) aimed to investigate which factors they perceive to enhance or impede medication information provision in primary care. Similarities and differences in perspectives were explored.Methods: Eight semistructured focus groups were conducted, four with type 2 diabetes patients (n=25) and four with both general practitioners (n=13) and health care assistants (n=10). Sessions were audio and video recorded, transcribed verbatim, and subjected to computer-aided qualitative content analysis.Results: Diabetes patients and HCPs broadly highlighted similar factors as enablers for satisfactory medication information delivery. Perceptions substantially differed regarding impeding factors. Both patients and HCPs perceived it to be essential to deliver tailored information, to have a trustful and continuous patient–provider relationship, to regularly reconcile medications, and to provide tools for medication management. However, substantial differences in perceptions related to impeding factors included the causes of inadequate information, the detail required for risk-related information, and barriers to medication reconciliation. Medication self-management was a prevalent topic among patients, whereas HCPs’ focus was on fulfilling therapy and medication management responsibilities.Conclusion: The findings suggest a noteworthy gap in perceptions between information provision and patients’ needs regarding medication-related communication. Medication safety and adherence may be improved if HCPs collaborate more closely with diabetes patients in managing their medication, in particular by incorporating the patients’ perspective. Health care systems need to be structured in a way that supports this process. Keywords: medication information, patient–provider communication, type 2 diabetes, focus groups, primary car

[The PRIMA Project - Electronically-Supported Physician-Pharmacist Cooperation to Generate and Update Medication Plans in Germany].

BACKGROUND:A complete overview on the patient's medication is one precondition for medication safety. For this, a complete and current medication plan (MP) is an appropriate instrument. We aimed to develop and implement software to evaluate and exchange medication plans in local software systems of general practitioners (GPs) and community pharmacies (CPs). Furthermore, it was the aim to evaluate feasibility and acceptance of the defined processes. METHODS:CPs and GPs were involved to pilot the software in several steps. Additionally, they generated and updated MP according to pre-defined processes and responsibilities. Feasibility and acceptance were evaluated in a survey and a workshop. RESULTS:For the first time in Germany, the technical requirements were established to generate and exchange MP electronically. Four software systems of CPs and one software system of GPs were involved. Solved Problems were technical errors, errors relevant for medication safety, differences in display of the medication data, and limited capacity of the barcode on the MP printout. Eleven GP and CP teams recruited 196 patients. 60 % were satisfied with the defined processes. 80 % of the GPs and 63 % of CPs agreed with the defined responsibilities. GPs considered the initial compilation on patient's medication in the CP as useful. The professional exchange between GPs and CPs improved: 70 % of GPs referred to increased knowledge on medication and 88 % of CPs received more information on patients' health conditions. The structured collaboration between GPs and CPs was considered to be important (25 %) or very important (75 %) for the quality of medication plans. DISCUSSION:An electronic MP was successfully implemented for the first time in local software systems. Processes and responsibilities were accepted by both professions. These are important prerequisites for sustainably implementing the MP in daily practice