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.

[The PRIMA Project - Electronically-Supported Physician-Pharmacist Cooperation to Generate and Update Medication Plans in Germany]. / Das Projekt PRIMA ­ Elektronische Erstellung und Aktualisierung von Medikationsplänen als gemeinsame Aufgabe von Ärzten und Apothekern.

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.

Synthesis and biological evaluation of spirocyclic antagonists of CCR2 (chemokine CC receptor subtype 2).

Activation of chemokine CC receptors subtype 2 (CCR2) plays an important role in chronic inflammatory processes such as atherosclerosis, multiple sclerosis and rheumatoid arthritis. A diverse set of spirocyclic butanamides 4 (N-benzyl-4-(3,4-dihydrospiro[[2]benzopyran-1,4'-piperidin]-1'-yl)butanamides) was prepared by different combination of spirocyclic piperidines 8 (3,4-dihydrospiro[[2]benzopyran-1,4'-piperidines]) and γ-halobutanamides 11. A key step in the synthesis of spirocyclic piperidines 8 was an Oxa-Pictet-Spengler reaction of ß-phenylethanols 5 with piperidone acetal 6. The substituted γ-hydroxybutanamides 11c-e were prepared by hydroxyethylation of methyl acetates 13 with ethylene sulfate giving the γ-lactones 14c and 14e. Aminolysis of the γ-lactones 14c and 14e with benzylamines provided the γ-hydroxybutanamides 15c-e, which were converted into the bromides 11c-e by an Appel reaction using polymer-bound PPh3. In radioligand binding assays the spirocyclic butanamides 4 did not displace the iodinated radioligand (125)I-CCL2 from the human CCR2. However, in the Ca(2+)-flux assay using human CCR2 strong antagonistic activity of butanamides 4 was detected. Analysis of the IC50-values led to clear relationships between the structure and the inhibition of the Ca(2+)-flux. 4g (4-(3,4-dihydrospiro[[2]benzopyran-1,4'-piperidin]-1'-yl)-N-[3,5-bis(trifluoromethylbenzyl)]-2-(4-fluorophenyl)butanamide) and 4o (N-[3,5-bis(trifluoromethyl)benzyl]-2-cyclopropyl-4-(3,4-dihydrospiro[[2]benzopyran-1,4'-piperidin]-1'-yl)butanamide) represent the most potent CCR2 antagonists with IC50-values of 89 and 17nM, respectively. Micromolar activities were found in the ß-arrestin recruitment assay with murine CCR2, but the structure-activity-relationships detected in the Ca(2+)-flux assay were confirmed.