Impact of a DSS-supported medication review on the safety of drug therapy and quality of life in patients with antithrombotic therapy

The use of antithrombotic therapy in patients, particularly those with multiple comorbidities, presents a significant challenge in the management of drug therapy. Polypharmacy is a prevalent phenomenon among this patient population, giving rise to concerns about Drug-Related Problems, which have the potential to compromise the safety and efficacy of treatment. It is therefore recommended that these patients be provided with a Medication Review in conjunction with pharmacist counseling in order to mitigate the risks associated with polypharmacy. This prospective, interventional study presents a concept for Medication Reviews that are applicable in German community pharmacies and can efficiently support pharmacist counseling and improve the safety of drug therapy. As this represents a significant challenge in the context of everyday pharmacy practice, we employed the use of a Decision Support System to evaluate its capacity to facilitate the process of pharmacist-led Medication Reviews. The primary endpoint was the impact of a community pharmacist on the reduction of Drug-Related Problems. The objective of this study was to investigate the impact of the interventions resulting from Medication Reviews on patients taking at least one antithrombotic drug as part of their polymedication regimen. Secondary endpoints included a reduction in the number of patients with bleeding risks and an improvement in patients' Quality of Life and therapy adherence. Furthermore, the Decision Support System used in the study was controlled for correct data assessment and plausibility of data. The study population consisted of adult patients who were taking a minimum of three distinct medications for long-term treatment, at least one of which was an antithrombotic drug, and who were customers at one of eight selected pharmacies over a period of six months. The Medication Review process was conducted in accordance with the relevant guidelines of the German Pharmacists Association (ABDA). This entailed the initiation of an anamnesis, which was conducted as an initial "brown-bag interview," and a final meeting within four weeks, wherein advice or adaptations to the drug therapy were provided to the patients, if necessary. The results were then compared with those of a structured follow-up interview conducted between one and six months later. The data from 87 patients (mean age 71 years, 47 females, 40 males) were analyzed with the assistance of the Decision-Support System. A total of 234 Drug-Related Problems were identified by the pharmacist, with an average of 2.7 DRPs per patient at baseline. Of these, 26.1% were related to antithrombotic medication and 73.9% were related to co-medication. Following the implementation of Medication Reviews, the number of Drug-Related Problems was reduced by 43.2%, resulting in a reduction of 1.2 DRPs per patient. Furthermore, the intervention resulted in a notable enhancement in the patients' Quality of Life (assessed via the EQ-5D-5L questionnaire; p < 0.001) and an increase in therapy adherence (assessed via the A14 questionnaire; p < 0.001). An external auditor evaluated the control of correct data assessment (with 93.8% concordance) and plausibility of data (with 91.7% concordance) of the Decision-Support System. No significant effect was found for overall bleeding risk. The findings of this study suggest that Decision Support System-facilitated and structured Medication Reviews conducted by pharmacists may contribute to a reduction in Drug-Related Problems and significantly enhance patients' Quality of Life and adherence to treatment.