What is the scope of pharmaceutical management

Medication management as a new pharmaceutical service

With the amendment to the pharmacy operating regulations in June 2012, medication management was included in the catalog of pharmaceutical activities. This means that pharmacies now have the option of offering medication management as a billable service to payers, doctors or patients. The German Pharmaceutical Society e. V. (DPhG) sees great potential in this development for the future of the profession, as in this way the competence of the pharmacist can be better used than before to improve patient safety. The DPhG therefore recommends creating the prerequisites for a comprehensive introduction of quality-assured medication management in pharmaceutical practice as soon as possible.

In order to improve drug safety, besides developing safe drugs, optimizing drug use is a crucial aspect. Scientific studies have repeatedly shown that the medication process has serious security gaps and that medication errors can lead to serious adverse drug events (UAE). Today there is consensus that these risks are unacceptable for the patient and that action is therefore required. Since the publication of the first action plan to improve drug therapy safety (AMTS) in Germany by the Federal Ministry of Health (BMG) in 2007, public interest in this topic has increased steadily.

The fourth ordinance amending the pharmacy operating rules describes medication management as a pharmaceutical activity "with which the patient's entire medication, including self-medication, is repeatedly analyzed with the aim of improving drug therapy safety and adherence by identifying and solving drug-related problems . " It was also determined that medication management must be carried out by a pharmacist. The pharmacy operating regulations hereby provide a template for the pharmacist to participate in measures to improve the AMTS.

However, the content and scope of medication management, which is also described differently in the international scientific literature, are open. In accordance with the Pharmaceutical Care Network Europe (PCNE), the DPhG recommends distinguishing between three different levels:

1. Simple medication management based on the data available in the pharmacy (e.g. prescriptions, self-medication, customer files). This can be used to identify duplicate prescriptions, interactions and implausible dosages.

2. An extended medication management as described under 1. with additional inclusion of further information from or about the patient. This can also be used to identify undesirable drug events, adherence problems and application errors.

3. Clinical medication management as described under 2. with the additional inclusion of medical data (e.g. diagnoses, laboratory data). This allows the medication to be checked for indications and contraindications and the dosage of the medication to be adjusted to the kidney and liver function.

The DPhG recommends the short-term implementation of simple and extended medication management in public pharmacies. Due to the time required and the necessary expertise, the DPhG calls on legislators, cost bearers and the profession to develop concepts for appropriate implementation and remuneration. Clinical medication management requires structural prerequisites that were previously only available in the inpatient area. In the outpatient sector, the cost bearers should create appropriate models that facilitate or require multi-professional collaboration.

In this context, the universities and chambers of pharmacists are called upon to firmly anchor the scientific and methodological foundations of medication management in basic, advanced and advanced training. An additional specialization, as it is already offered in some chamber areas, would be desirable here. For a sustainable establishment, it is also essential to scientifically evaluate the quality of the results of medication management for the various patient groups. This research should be carried out at pharmaceutical institutes, ideally in the field of clinical pharmacy.

The DPhG is convinced that the implementation of medication management is of great benefit for the patient, doctor and cost bearer, as it contributes to the avoidance of medication errors and thus to improved drug therapy safety. In this way, medication management further develops the supply of medicines close to home and should therefore be an essential cornerstone of a future model for the pharmacist's profession. The DPhG offers its support for implementation in teaching, research and practice.

Pharmacist Olaf Rose, Pharm.D., Elefanten-Apotheke, Steinfurt
Prof. Dr. Ulrich Jaehde, University of Bonn
Prof. Dr. Kristina Leuner, University of Erlangen-Nuremberg
Prof. Dr. Christoph Ritter, University of Greifswald
Pharmacist Kathrin Müller, Vice President
Dr. Thomas Maschke, Vice President Finance
Prof. Dr. Dieter Steinhilber, President