What do laypeople consider 'medication' and are they aware of modulators of a drug's effects?

OBJECTIVES: Healthcare providers expect patients to be responsible partners during drug treatment, who know potential risks impeding drug effects and are able to accurately report prescribed and non-prescribed medication. This presumes that they have the same understanding of the term 'medication' as healthcare providers. We assessed which products laypeople label as medication and which modulators of drug effects they know. METHODS: People visiting the otorhinolaryngology outpatient clinic at a university hospital were invited to anonymously complete a questionnaire assessing which products out of 23 listed examples are medications and valuing 12 modulators potentially influencing drug effects. RESULTS: Among 94 participants, 86 (91.5%) identified on average 14.4±3.3 (62.6%) of the products and 79 (84.0%) identified 6.7±2.0 (55.5%) of the modulators correctly. Women performed better than men (p<0.01). Regular medication intake, education level and age did not influence the results. CONCLUSIONS: Laypeople are at risk of misclassifying medications and modulators of drug effects.

Development of a standardized knowledge base to generate individualized medication plans automatically with drug administration recommendations.

AIMS: We aimed to develop a generic knowledge base with drug administration recommendations which allows the generation of a dynamic and comprehensive medication plan and to evaluate its comprehensibility and potential benefit in a qualitative pilot study with patients and physicians. METHODS: Based on a literature search and previously published medication plans, a prototype was developed and iteratively refined through qualitative evaluation (interviews with patients and focus group discussions with physicians). To develop the recommendations for safe administration of specific drugs we screened the summary of product characteristics (SmPC) of different exemplary brands, allocated the generated advice to groups with brands potentially requiring the same advice, and reviewed these allocations regarding applicability and appropriateness of the recommendations. RESULTS: For the recommendations, 411 SmPCs of 140 different active ingredients including all available galenic formulations, routes of administrations except infusions, and administration devices were screened. Finally, 515 distinct administration recommendations were included in the database. In 926 different generic groups, 29,879 allocations of brands to general advice, food advice, indications, step-by-step instructions, or combinations thereof were made. Thereby, 27,216 of the preselected allocations (91.1%) were confirmed as appropriate. In total, one third of the German drug market was labelled with information. CONCLUSIONS: Generic grouping of brands according to their active ingredient and other drug characteristics and allocation of standardized administration recommendations is feasible for a large drug market and can be integrated in a medication plan.

Opportunities to reduce medication regimen complexity: a retrospective analysis of patients discharged from a university hospital in Germany.

BACKGROUND: Numerous characteristics of a medication regimen can weaken patient adherence to drug therapy and thus impair clinical outcomes of drug therapy. OBJECTIVE: The aim of the study was to investigate the prevalence of medication regimen characteristics that are known to reduce patient adherence to drug therapy. Furthermore, we assessed to what extent complex medication regimens can possibly be simplified through different strategies. METHODS: We retrospectively evaluated the medication regimens of 500 consecutive patients discharged from the University Hospital of Heidelberg, Germany, in whom the dosages of all drugs were specified. The medication regimens were extracted from the discharge letters issued between 1 January 2007 and 29 December 2007. Each medication regimen was checked for the presence of seven regimen characteristics that are known to reduce patient adherence, and theoretical viable strategies to avoid four of the respective characteristics were identified. The extent of possible simplification through the identified strategies was evaluated for the overall study population and the subgroup of elderly patients (≥65 years) with polypharmacy (≥5 drugs). RESULTS: On average, every medication regimen in the overall study population had 2.9±1.7 (standard deviation) characteristics (range 0-7) known to impair patient adherence. In contrast, the medication regimens of elderly patients with polypharmacy contained 3.7±1.6 characteristics (range 0-7) known to impair patient adherence. The most prevalent complexity characteristics in the overall study population were prescription of ≥1 drug with multiple doses per day (441 patients), ≥3 drugs with different dosing intervals (349 patients), tablet splitting (223 patients), followed by ≥12 daily drug administrations (190 patients). Almost half of the prescribed tablet splitting could be prevented. Moreover, 17.9% of the multi-dose prescriptions could be switched to once-daily dosing, and thus reduced the number of drugs with different dosing intervals and the number of daily drug administrations. The combined intervention reduced the total number of potentially preventable complexity characteristics by 18.3% (from 2283 to 1865 characteristics) without reducing prescription quality. CONCLUSION: Almost one-fifth of all regimen complexity characteristics relevant for patient adherence were avoidable by simple modifications of the medication scheme, stressing the need for targeted interventions.