International Journal of Clinical Pharmacy

, Volume 38, Issue 6, pp 1425–1435 | Cite as

The status of the performance of medication reviews in German community pharmacies and assessment of the practical performance

  • Claudia Greißing
  • Katharina Kössler
  • Johanna Freyer
  • Lucie Hüter
  • Peter Buchal
  • Susanne Schiek
  • Thilo Bertsche
Research Article


Background Pharmacist-led medication reviews have shown to prevent drug-related problems (DRPs). So far, data is rare about the implementation in routine care, the conditions for intensifying this service and the practical skills of community pharmacists to perform medication reviews. Objective To assess the current status of medication review implementation in German community pharmacies and the performance of identifying DRPs in a ficticious patient example. Setting German community pharmacies. Method An online survey was conducted from July to September 2015 including questions about medication reviews currently performed in routine care of community pharmacies and hidden DRPs in a ficticious patient example. Pharmacists were invited via newsletters from three local chambers of pharmacists. Main outcome measure (i) Frequency, conditions for implementation, and criteria of medication reviews currently being performed in routine care, (ii) requested further information to perform medication reviews, and (iii) proportion of pharmacists who identify DRPs in the patient example. Results A total of 143 community pharmacists completed the questionnaire. (i) One hundred and twenty-seven respondents (89 %) reported reviewing the medication regularly in routine care, whereas 56 (39 %) stated that they performed medication reviews between one and five times monthly. For 124 pharmacists (87 %), remuneration would be a necessary condition for performing medication reviews more frequently. When reviewing the medication, 112 (78 %) of the pharmacists considered the criterion ‘drug–drug interactions’ and 107 (75 %) reviewed the criterion ‘correct dosage’. One of the least reviewed criteria was ‘effectiveness of medication’ [22 (16 %)]. (ii) According to the participants, laboratory values should be available in the community pharmacy, since 87/143 (61 %) would appreciate the GFR and the HbA1c level. Twenty-two of 54 respondents (41 %) would appreciate further administration instructions and 5 of 54 (15 %) think they would benefit from information about the recommended duration of drug use. (iii) Depending on the category, 4 (3 %) to 49 (34 %) of all 143 pharmacists identified the hidden DRP in the patient example. Conclusion German community pharmacists reported reviewing the medication of their patients regularly; however, most of the respondents review the medication very rarely in routine care. Consequently, their practical performance needs to be improved.


Community pharmacists Drug-related problems Germany Implementation Medication review Online questionnaire Practical performance 



We would like to thank the community pharmacists for participating and the Baden-Württemberg, the Westphalia-Lippe, and the Saxon Local Chamber of Pharmacists for supporting this project. We would like to thank Manuela and John O’Hanlon and Lena Schrader for their language proof of the manuscript and Benjamin R. Auer for the statistical counselling.


This study was supported by the Baden-Württemberg Chamber of Pharmacists.

Conflicts of interest

All Authors and acknowledged persons declare that they have no conflict of interest concerning this paper.

Supplementary material

11096_2016_381_MOESM1_ESM.docx (23 kb)
Supplementary material 1 (DOCX 22 kb)


  1. 1.
    Pharmaceutical Care Network Europe Foundation. PCNE. Classification for Drug related problems (revised 01-05-06vm. V5.01.). [cited 2016 Jul 7].
  2. 2.
    Mekonnen AB, McLachlan AJ, Jo-anne EB. Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: a systematic review and meta-analysis. BMJ Open. 2016;6(2):e010003.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Geer MI, Koul PA, Tanki SA, Shah MY. Frequency, types, severity, preventability and costs of adverse drug reactions at a tertiary care hospital. J Pharmacol Toxicol Methods. 2016;81:323–34.PubMedCrossRefGoogle Scholar
  4. 4.
    Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. Adverse drug events occurring following hospital discharge. J Gen Intern Med. 2005;20(4):317–23.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Paulino EI, Bouvy ML, Gastelurrutia MA, Guerreiro M, Buurma H. Drug related problems identified by European community pharmacists in patients discharged from hospital. Pharm World Sci. 2004;26(6):353–60.PubMedGoogle Scholar
  6. 6.
    Stausberg J, Hasford J. Drug-related admissions and hospital-acquired adverse drug events in Germany: a longitudinal analysis from 2003 to 2007 of ICD-10-coded routine data. BMC Health Serv Res. 2011;11:134–43.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Chau SH, Jansen APD, van de Ven PM, Hoogland P, Elders PJM, Hugtenburg JG. Clinical medication reviews in elderly patients with polypharmacy: a cross-sectional study on drug-related problems in the Netherlands. Int J Clin Pharm. 2016;38(1):46–53.PubMedCrossRefGoogle Scholar
  8. 8.
    Geurts MME, Stewart RE, Brouwers JRBJ, de Graeff PA, de Gier JJ. Implications of a clinical medication review and a pharmaceutical care plan of polypharmacy patients with a cardiovascular disorder. Int J Clin Pharm. 2016;38(4):808–15.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Milos V, Rekman E, Bondesson Å, Eriksson T, Jakobsson U, Westerlund T, et al. Improving the quality of pharmacotherapy in elderly primary care patients through medication reviews: a randomised controlled study. Drugs Aging. 2013;30(4):235–46.PubMedCrossRefGoogle Scholar
  10. 10.
    Wolf C, Pauly A, Mayr A, Grömer T, Lenz B, Kornhuber J, et al. Pharmacist-led medication reviews to identify and collaboratively resolve drug-related problems in psychiatry—a controlled, clinical trial. PLoS One. 2015;10(11):e0142011.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Jokanovic N, Tan ECK, van den Bosch D, Kirkpatrick CM, Dooley MJ, Bell JS. Clinical medication review in Australia: a systematic review. Res Soc Adm Pharm. 2016;12(3):384–418.CrossRefGoogle Scholar
  12. 12.
    Ocampo CC, Garcia-Cardenas V, Martinez-Martinez F, Benrimoj SI, Amariles P, Gastelurrutia MA. Implementation of medication review with follow-up in a Spanish community pharmacy and its achieved outcomes. Int J Clin Pharm. 2015;37(5):931–40.PubMedCrossRefGoogle Scholar
  13. 13.
    Pharmaceutical Care Network Europe Foundation. Medication review definition approved. [cited 2016 Jul 7].
  14. 14.
    ABDA—Federal Union of German Associations of Pharmacists. Position paper on medication review and medication management: overview about the different concepts of medication review and medication management as pharmaceutical task (state: 24.06.2014). [cited 2016 Jul 6].
  15. 15.
    Modig S, Holmdahl L, Bondesson Å. Medication reviews in primary care in Sweden: importance of clinical pharmacists’ recommendations on drug-related problems. Int J Clin Pharm. 2016;38(1):41–5.PubMedCrossRefGoogle Scholar
  16. 16.
    Curtain C, Peterson GM. Review of computerized clinical decision support in community pharmacy. J Clin Pharm Ther. 2014;39(4):343–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Watkins K, Wood H, Schneider CR, Clifford R. Effectiveness of implementation strategies for clinical guidelines to community pharmacy: a systematic review. Implement Sci. 2015;10:151.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Bertsche T, Askoxylakis V, Habl G, Laidig F, Kaltschmidt J, Schmitt SPW, et al. Multidisciplinary pain management based on a computerized clinical decision support system in cancer pain patients. Pain. 2009;147(1–3):20–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Lenssen R, Heidenreich A, Schulz JB, Trautwein C, Fitzner C, Jaehde U, et al. Analysis of drug-related problems in three departments of a German University hospital. Int J Clin Pharm. 2016;38(1):119–26.PubMedCrossRefGoogle Scholar
  20. 20.
    Bertsche T, Pfaff J, Schiller P, Kaltschmidt J, Pruszydlo MG, Stremmel W, et al. Prevention of adverse drug reactions in intensive care patients by personal intervention based on an electronic clinical decision support system. Intensive Care Med. 2010;36(4):665–72.PubMedCrossRefGoogle Scholar
  21. 21.
    Mast R, Ahmad A, Hoogenboom SC, Cambach W, Elders PJM, Nijpels G, et al. Amsterdam tool for clinical medication review: development and testing of a comprehensive tool for pharmacists and general practitioners. BMC Res Notes. 2015;8:642.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Koster ES, Philbert D, Noordam M, Winters NA, Blom L, Bouvy ML. Availability of information on renal function in Dutch community pharmacies. Int J Clin Pharm. 2016;38(4):797–801.PubMedCrossRefGoogle Scholar
  23. 23.
    Mahler C, Jank S, Pruszydlo MG, Hermann K, Gärtner H, Kaltschmidt J, et al. HeiCare®: Ein Projekt zur Verbesserung der sektorenübergreifenden Arzneimittelkommunikation. DMW. 2011;136(44):2239–44.CrossRefGoogle Scholar
  24. 24.
    Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007;297(8):831–41.PubMedCrossRefGoogle Scholar
  25. 25.
    Sorensen L, Stokes JA, Purdie DM, Woodward M, Elliott R, Roberts MS. Medication reviews in the community: results of a randomized, controlled effectiveness trial. Br J Clin Pharmacol. 2004;58(6):648–64.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Houle SKD, Grindrod KA, Chatterley T, Tsuyuki RT. Paying pharmacists for patient care: a systematic review of remunerated pharmacy clinical care services. Can Pharm J. 2014;147(4):209–32.CrossRefGoogle Scholar
  27. 27.
    Chamber of Pharmacists Baden-Württemberg. ATHINA: Pharmacies review the medication mix; 2014 [cited 2015 Sep 8].
  28. 28.
    ARMIN. Medication initiative Sachsen-Thüringen [cited 2016 Feb 8].
  29. 29.
    Leiner DJ. SoSci Survey (Version 2.6.00-i) [cited 2016 Feb 8].
  30. 30.
    Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM, Lewis IK, et al. A method for assessing drug therapy appropriateness. J Clin Epidemiol. 1992;45(10):1045–51.PubMedCrossRefGoogle Scholar
  31. 31.
    Browne C, Kingston C, Keane C. Falls prevention focused medication review by a pharmacist in an acute hospital: implications for future practice. Int J Clin Pharm. 2014;36(5):969–75.PubMedCrossRefGoogle Scholar
  32. 32.
    O’Sullivan D, O’Mahony D, O’Connor MN, Gallagher P, Cullinan S, O’Sullivan R, et al. The impact of a structured pharmacist intervention on the appropriateness of prescribing in older hospitalized patients. Drugs Aging. 2014;31(6):471–81.PubMedCrossRefGoogle Scholar
  33. 33.
    Guignard B, Bonnabry P, Perrier A, Dayer P, Desmeules J, Samer CF. Drug-related problems identification in general internal medicine: the impact and role of the clinical pharmacist and pharmacologist. Eur J Intern Med. 2015;26(6):399–406.PubMedCrossRefGoogle Scholar
  34. 34.
    Skoog J, Midlöv P, Beckman A, Sundquist J, Halling A. Indication for pharmacological treatment is often lacking: a cross-sectional study on the quality of drug therapy among the elderly. BMC Geriatr. 2015;15:117.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Adam H, Niebling W, Schott G. The information about discharge medication: what do general practitioners need? Dtsch Med Wochenschr. 2015;140(8):e74–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Roth-Isigkeit A, Harder S. Reporting the discharge medication in the discharge letter. An explorative survey of family doctors. Med Klin. 2005;100(2):87–93.CrossRefGoogle Scholar
  37. 37.
    Hurkens KPGM, Mestres-Gonzalvo C, de Wit HAJM, van der Kuy PHM, Janknegt R, Verhey F, et al. Usually available clinical and laboratory data are insufficient for a valid medication review: a Crossover study. J Nutr Health Aging. 2016;20(1):71–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Bertsche T, Nachbar M, Fiederling J, Schmitt SPW, Kaltschmidt J, Seidling HM, et al. Assessment of a computerised decision support system for allergic rhino-conjunctivitis counselling in German pharmacy. Int J Clin Pharm. 2012;34(1):17–22.PubMedCrossRefGoogle Scholar
  39. 39.
    de Wit HAJM, Gonzalvo CM, Hurkens KPGM, Mulder WJ, Janknegt R, Verhey FR, et al. Development of a computer system to support medication reviews in nursing homes. Int J Clin Pharm. 2015;35(5):668–72.CrossRefGoogle Scholar
  40. 40.
    Zaal RJ, Jansen MMPM, Duisenberg-van Essenberg M, Tijssen CC, Roukema JA, van den Bemt PMLA. Identification of drug-related problems by a clinical pharmacist in addition to computerized alerts. Int J Clin Pharm. 2013;35(5):753–62.PubMedCrossRefGoogle Scholar
  41. 41.
    O’Connell MB, Chang F, Tocco A, Mills ME, Hwang JM, Garwood CL, et al. Drug-related-problem outcomes and program satisfaction from a comprehensive brown bag medication review. J Am Geriatr Soc. 2015;63(9):1900–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing 2016

Authors and Affiliations

  • Claudia Greißing
    • 1
    • 2
    • 3
  • Katharina Kössler
    • 1
    • 2
    • 3
  • Johanna Freyer
    • 2
    • 3
  • Lucie Hüter
    • 2
    • 3
  • Peter Buchal
    • 1
  • Susanne Schiek
    • 2
    • 3
  • Thilo Bertsche
    • 2
    • 3
  1. 1.Pharmacy DepartmentKlinikum KonstanzConstanceGermany
  2. 2.Drug Safety CenterLeipzig University and University Hospital of LeipzigLeipzigGermany
  3. 3.Department of Clinical Pharmacy, Institute of PharmacyLeipzig UniversityLeipzigGermany

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