From Katja Renner/Medication Management makes an important contribution to improving drug therapy safety (AMTS). A practical project of the Nordrhein Pharmaceutical Chamber shows how this pharmacy service can be implemented in every pharmacy.
ATHINA is the concept that started 2013 as a pilot project with 38 pharmacists. It is aimed in particular at colleagues who have not been trained in clinical pharmacy and provides a structured, systematic approach to the creation of medication management. In addition, the participants test the working methodology practically on the basis of a so-called Brown Bag review. Pharmaceuticals in public pharmacies are specifically trained by ATHINA to:
- to identify, avoid or minimise drug-related interactions and other drug-related problems;
- to provide the patient with the correct dosage and administration of his/her medicinal products,
- together with him to clarify the reason for the treatment and thus
- to maximise overall patient consistency for its drug therapy; and
- ensure the success of therapy.
Following the definition of the Pharmaceutical Care Network Europe (PCNE), the ATHINA approach is to be classified as an intermediate medication management. The medical analysis is based on the medical data and patient data and does not explicitly require knowledge of laboratory values and medical diagnosis, a situation which in most cases is likely to correspond to the reality in the Offizin.
Prior to the actual analysis, the pharmacist conducts an intensive history discussion with the patient, in which he learns his or her knowledge of his or her illnesses, drug use and drug-related problems. If available, the physician's medical plan will be reviewed for its topicality, but the medical analysis may, but does not need to, be continued in a continuous patient care in the sense of medication management.
Standardised record sheet
ATHINA's pivot and focal point is an electronic record sheet that facilitates the systematic absorption of all medicinal products of a patient. Among other things, it provides space for doses, indications and problems, as well as their solutions and measures by the pharmacy. When completing the sheet, the patient will automatically draw up and print out an up-to-date medication plan. This format corresponds to the specification for a patient-related medication plan in accordance with the AMTS Action Plan of the Federal Ministry of Health. He still needs to be cleared by the doctor.
The participants work four patient cases within four months and send them to the board's project coordinator. They have a tutor team at their side. The first case and, if necessary, other cases of each participant are examined by a tutor. The feedback of the tutors includes specific technical notes on the patient case, indications on guidelines et cetera and serves as quality assurance for the pharmacist. All ATHINA arches are documented in anonymous form for later evaluation at the coordinating body.
In the Chambers of Lower Saxony, Hesse and Baden-Wuerttemberg, ATHINA training sessions are also held by the speakers from North Rhine-Westphalia. In addition, joint case presentations for ATHINA participants in the form of webinars are offered together with the Lower Saxony Chamber. In doing so, the speakers in 45-minute training units provide up-to-date information on various indications based on real patient cases and make recommendations for patient-oriented medication management. Close cooperation with other AMTS projects, such as Apo-AMTS of the Pharmaceutical Chamber of Westphalia Lippe (see also PZ 43/2013, page 22) or ARMIN of the Federal Pharmaceutical Chamber, is carried out in the evaluation of the cases collected.
First results
Although the data of the current ATHINA courses have not yet been fully evaluated, trends can already be seen. The pilot study evaluated the medical analysis of 180-patients. 70%of the patients treated were between 70's and 80's. On average, patients took 9,3 drugs regularly, but were only able to present a medication plan in approximately half of the cases. The examination of the medicines brought, the preparation of the medication plan and the final discussion with the patient lasted in the middle of 90 minutes. Further data are expected to provide a joint evaluation of more than 200 cases from Lower Saxony and North Rhine in the summer.
The feedback from participants and patients is very positive. In the evaluation, both sides praise the safety gains: patients feel safer in their drug therapy and pharmacists gain safety in drug management. "Our goal is to bring ATHINA to the surface. Because we believe that a practical management of medication is a service that strengthens our pharmacy competence, ensures the professional status, and is simply fun,"summarises Lutz Engelen, President of the Chamber of Pharmaceuticals of North Rhine.
The ATHINA project
ATHINA was initiated by a working group of the Pharmaceutical Chamber of North Rhine Training Committee by PharmD Bernd Dewald (project leader), Wolfgang Groning, Diet Lange and D r Katja Renner with the support of the National Commissioner for Pharmaceutical Care and AMTS Manfred Kruger and the Management Board of the Pharmaceutical Chamber. Further information can be found at www.aknr.de/ATHINA.