The Institute of Pharmacy at Freie Universität Berlin is the first of its kind in Germany to integrate the field of medication management into the education of its pharmacy students. The goal is to put theoretical knowledge into practice even before the students have completed their study programs. This includes training on how to give patients professional advice in a pharmacy setting and on pharmaceutical services offered at pharmacies. The expansion of the study program to include practical aspects of teaching comes in response to rising life expectancies, which mean that more patients suffer from multiple diseases or conditions, giving rise to issues involved with taking multiple medications. In this context, studies by the Institute of Pharmacy and the Drug Commission of German Pharmacists (AMK) have also received support from the German Federal Ministry of Health (BMG). The results of these studies were used toward the implementation of the E-Health Act, which took effect in January 2016. Among its other provisions, the new law establishes a guarantee, effective October 1, of a medication plan for all insured patients who take three or more prescription drugs on a long-term basis (Sec. 31a of the German Code of Social Laws (SGB) V).
The newly opened Medication Management Center at the Institute of Pharmacy at Freie Universität Berlin, which will help to provide training and education with a focus on real-world practice for pharmacy students, also includes a model pharmacy. In a true-to-life setting and using real-world cases that have been anonymized, students learn not only how to develop possible solutions, but also how to implement them in patient care by doing things like advising patients and explaining the effects and interactions of certain medications and drug dosages to them in layman’s terms. They also learn how to draw up a medication plan documenting all prescription and over-the-counter medications that the patient is taking, check the plan for drug therapy safety risks, and keep it up to date. In addition, students receive training on other pharmaceutical services, such as taking a patient’s blood pressure, advising patients on how to handle asthma inhalers, and administering subcutaneous injections, for example to administer insulin to diabetic patients with a placebo pen.
Effective October 1, 2016, patients who use three or more prescription drugs are entitled to have a medication plan prepared and issued to them, initially in paper form. This is one of the provisions of the E-Health Act, which has inserted a new paragraph, 31a, into the fifth book of Germany’s Code of Social Laws (SGB V). A study conducted by the Institute of Pharmacy and the Drug Commission of German Pharmacists in 2015 showed that many people, especially older individuals, who have to take multiple medications regularly have difficulties understanding even the new medication plan, which has been standardized nationwide. As a result, they may take their medications improperly, giving rise to avoidable risks. The study showed that fewer than half of patients were able to fill a pill organizer – a storage case into which a week’s worth of the patient’s daily medications are sorted – correctly according to a specified medication plan. This finding shows that a significant portion of patients who take multiple medications need not only an up-to-date, complete medication plan, but also more extensive support from medical professionals.
According to information from the BMG, about five percent of all hospital admissions are due to the side effects of medications, and one-quarter of them are preventable. That means about 250,000 hospital admissions each year are attributable to preventable drug errors. The costs associated with this amount to more than one billion euros.
The goal of the medication plan is twofold. First, it is intended to enhance patient safety. Second, it is supposed to give physicians and pharmacists and better, comprehensive overview of the medications a patient is taking and reveal and resolve possible drug errors, thereby improving drug therapy on a long-term basis.