Patients’ Use of a Standardized Medication List - A Mixed Methods Study

Abstract

Christiane Eickhoff,1 Uta Müller,1 Sophie Thomas,2 Christian Schmidt,2 Lisa Sophie Hartling,3 Sebastian Michael,3,4 Martin Schulz,1,5 Thilo Bertsche2,6 1Department of Medicine, ABDA – Federal Union of German Associations of Pharmacists, Berlin, Germany; 2Clinical Pharmacy Department, Institute of Pharmacy, Medical Faculty, Leipzig University, Leipzig, Germany; 3Löwen-Apotheke Waldheim e.K, Waldheim, Germany; 4Saxon Pharmacists Association, Leipzig, Germany; 5Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany; 6Drug Safety Center, Medical Faculty, Leipzig University and Leipzig University Hospital, Leipzig, GermanyCorrespondence: Christiane Eickhoff, Department of Medicine, ABDA – Federal Union of German Associations of Pharmacists, Heidestrasse 7, Berlin, 10557, Germany, Tel [phone], Fax [phone], Email [email protected]: A medication list (ML) is a document listing the patient’s entire medication, instructions for use, and indications. In Germany, a national standard was established in 2016 by law. However, data on patients’ use of this standardized ML are scarce. We investigated (i) patients’ practical use of the ML, (ii) patients’ understanding of the ML, (iii) completeness and correctness of the current ML version, and (iv) reasons why patients did not adhere to their ML.Patients and Methods: Community pharmacists recruited patients possessing a standardized ML with ≥ 5 medications. Information sources to evaluate the ML were: (a) brown bag analysis, (b) practical demonstration, (c) patient interview, and (d) patient file. Data were analyzed using qualitative and quantitative methods.Results: Two hundred and eighty-eight patients (median age: 76 years, range: 27– 95) were enrolled. (i) 38.5% of the patients used their ML regularly to prepare their medication and 73.3% to inform their physician. (ii) Overall, patients’ understanding of the ML was good, with > 80% of the patients being able to identify all relevant information. (iii) While n = 2779 medications were actually taken, n = 2539 were documented on the ML. No ML was fully correct and complete. Regarding particularly relevant items, ie, active ingredient, strength, dosage, medication missing or listed but not taken, 79.2% of ML were incorrect or incomplete. Handwritten modifications on the ML were frequent. (iv) Almost 60% of all patients did not follow their ML with “fear of adverse drug reactions” being the most frequently (n = 50) mentioned reason.Conclusion: Completeness and correctness of the current ML version was poor with handwritten modifications being frequent. Additionally, most of the patients did not adhere to their ML. This indicates that measures that lead to correct and up-to-date ML and improvements in patient counseling about their medication should be developed and implemented into routine practice.Keywords: medication list, medication schedule, medication plan, community pharmacy, medication safety, polypharmacy

Keywords

• medication list
• medication schedule
• medication plan
• community pharmacy
• medication safety
• polypharmacy