Detection of drug related problems in an interdisciplinary health care model for rural areas in Germany.

Objective: The disparity between an increasing complexity of patients' treatment and the declining number of general practitioners (GP) require action. The AGnES-concept (general practitioner-relieving, community-based, e-health assisted, systemic intervention) is based on the delegation of original physician-activities to qualified AGnES-practice assistants. Purposes of AGnES part 1 were to determine the feasibility of community-based home medication reviews (HMR) and the establishment of a health professional network to identify drug related problems (DRP) in the domicile of elderly patients. Two consecutive studies (AGNES 2 + 3) were conducted to implement HMR.

Setting: General practices on the isle of Rugia in Mecklenburg-Western Pomerania, a German rural area. Patients who receive regular home visits by their GP were addressed.

Method: Study-instruments for the feasibility study (AGnES 1) were designed by an expert panel and modified for the implementation (AGnES 2 + 3) studies. HMR were conducted by additionally qualified AGnES-practice assistants regarding DRP like drug-drug interaction (DDI), adverse drug reactions (ADR), and compliance. DRP-selection was inspired by the coding system Pi-Doc. Pharmacists checked DRP and intervened, if necessary. 18 (AGnES 1) and 60 (AGnES 2 + 3) geriatric patients received a minimum of two home visits by an AGnES-practice assistant.

Main Outcome Measure: Feasibility was assessed by patients' satisfaction with care provided by the AGnES-practice assistant. For implementation reported DRP and the conducted interventions were evaluated.

Results: During AGnES 1 a documentation sheet was developed and tested. 56 potential DDI were identified. 37 of 112 drugs which caused potential interactions were attributed to OTC medication and food components. 84% of respondents judged the systematic evaluation of their pharmacotherapy as helpful. During AGnES 2 + 3 local pharmacists identified DDIs in 45% of patients. Seven patients (11.6%) reported at least one ADR attributable to their current medication. Those patients who received a second HMR (n = 29) during AGnES 2 + 3 rated the HMR as reasonable 65.5% (n = 19), and partly reasonable 24.1% (n = 7).

Conclusions: By comprehensive HMR conducted by AGnES-practice assistants in delegation of the patients' GPs in cooperation with local pharmacists we could identify a considerable prevalence of DRP under real-life conditions. Further studies should recruit more participants including a control group with usual care.