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Frequency and determinants of potential drug-drug interactions in an elderly population receiving regular home visits by GPs - results of the home medication review in the AGnES-studies

Authors

  • Wolfgang Hoffmann,

    Corresponding author
    1. Center for Integrated Dementia Care Research (CIDC), a cooperation between the Universities Rostock and Greifswald and the German Center for Neurodegenerative Diseases (Deutsches Zentrum für Neurodegenerative Erkrankungen in der Helmholtz Gemeinschaft DZNE), Greifswald, Germany
    • Institute for Community Medicine, Dept. Epidemiology of Health Care and Community Health, Ernst Moritz Arndt University of Greifswald, Greifswald, Germany
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  • Neeltje van den Berg,

    1. Institute for Community Medicine, Dept. Epidemiology of Health Care and Community Health, Ernst Moritz Arndt University of Greifswald, Greifswald, Germany
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  • Jochen René Thyrian,

    1. Center for Integrated Dementia Care Research (CIDC), a cooperation between the Universities Rostock and Greifswald and the German Center for Neurodegenerative Diseases (Deutsches Zentrum für Neurodegenerative Erkrankungen in der Helmholtz Gemeinschaft DZNE), Greifswald, Germany
    2. German Center for Neurodegenerative Diseases (Deutsches Zentrum für Neurodegenerative Erkrankungen DZNE), location site Rostock / Greifswald, Greifswald, Germany
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  • Thomas Fiss

    1. Center for Integrated Dementia Care Research (CIDC), a cooperation between the Universities Rostock and Greifswald and the German Center for Neurodegenerative Diseases (Deutsches Zentrum für Neurodegenerative Erkrankungen in der Helmholtz Gemeinschaft DZNE), Greifswald, Germany
    2. German Center for Neurodegenerative Diseases (Deutsches Zentrum für Neurodegenerative Erkrankungen DZNE), location site Rostock / Greifswald, Greifswald, Germany
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W. Hoffmann, Institute for Community Medicine, Dept. Epidemiology of Health Care and Community Health, Ernst Moritz Arndt University of Greifswald, Ellernholzstreet 1/2, 17487 Greifswald Germany. E-mail: wolfgang.hoffmann@uni-greifswald.de

ABSTRACT

Purpose

There is limited knowledge about prevalence and determinants of potential drug-drug-interactions (pDDI) in the ambulatory health care setting. In this manuscript we analysed the prevalence and determinants of pDDI in the AGnES home visit population (GP-supporting, community-based, e-health-assisted, systemic intervention).

Methods

779 Home-dwelling patients received an IT-supported home medication review (HMR). The interaction monographs of the ABDA-database were used to identify pDDI. A binary multivariate logistic regression model was used to analyse determinants for occurrence of moderate and serious pDDI, respectively.

Results

Patients (mean age f: 79.8 yrs; m: 76.2 yrs) took a mean number of 6.8 active substances (SD = 3.3) regularly. 626 patients (80.4%) with an HMR had at least one pDDI (mean = 4.8; SD = 4.4). In 454 patients (58.3%) we found at least one pDDI with moderate or serious relevance (mean = 2.9; SD = 2.8). The most frequent moderate pDDI was the combination of potassium excretion diuretics (e.g. hydrochlorothiazide) with anti-inflammatory drugs (e.g. ibuprofen; n = 258 patients). Adjusted for age and gender, multiple binary logistic regression showed significant results for the number of taken active substances (continuous variable; OR = 1.48; 95%-CI 1.382-1.585), metabolic diseases (OR = 1.52; 95%-CI 1.039-2.223), a diagnose of a muscular-skeletal disease (OR = 1.741; 95%-CI 1.204-2.517), infectious disease (OR = 0.127; 95%-CI 0.021-0.783), and gastro-intestinal disease (OR = 0.538; 95%-CI 0.322-0.899).

Conclusion

Using a comprehensive, computer-assisted HMR in an ambulatory care setting we have identified a high proportion of pDDI of moderate or serious clinical relevance. These pDDI require an intervention from intensified monitoring to a change in medication. Further investigations should focus on clinical outcome of pDDI. Copyright © 2011 John Wiley & Sons, Ltd.

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