Implementing standardized medication plans in ambulatory care – Are they correct and do patients follow their plan?

Abstract

Purpose The standardized medication plan (MP) is a document listing the patients’ entire medication, instructions for use, and indications in a nationally defined format. However, there is currently little data on its practical implementation, comprehensibility, and use at the patient level. We aimed to investigate under routine conditions (i) patients’ competencies in using the MP, (ii) completeness and correctness of the MP including handwritten modifications, and (iii) patients’ reasons for deviating from the MP. Methods We conducted face-to-face interviews with patients in community pharmacies. Data was analyzed with qualitative and quantitative methods. Results We enrolled 288 patients (median age: 76 years, range: 27–95) with n=2,779 medications actually taken and n=2,539 medications documented on the MPs. 38.5% of the patients used their MP regularly to prepare their medication and 73.3% used it to inform their physician. (i) Overall, patients’ orientation and understanding the MP was good. (ii) No MP was correct and complete. When taking only relevant aspects into account, i.e. active ingredient, strength, dosage, medication missing or listed but not taken, 79.2% (n=228) were incorrect or incomplete. With 25.8% of the total number of handwritten modifications (n=341) most often medications were added. (iii) Almost 60% of all patients deliberately deviated from their MP, “fear of adverse drug reactions” was the most frequently (n=50) mentioned reason. Conclusion The patients’ competence in understanding their MP was good. However, important information was often missing or incorrect; therefore, handwritten modifications were frequently added. Patients often deliberately deviated from their MP for various reasons.