Strategien zur Verbesserung der Einnahmetreue von Medikamenten

 

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Zusammenfassung

Bis zu 50 % der Patienten mit chronischen Erkrankungen nehmen ihre Medikation nicht oder unregelmäßig ein. Eine geringe Einnahmetreue ist mit einer erhöhten Morbidität und Mortalität assoziiert.

Es wurde eine selektive Literatursuche mit den deutschen und englischen Begriffen für Einnahmetreue, Therapietreue, Compliance, Persistenz, Adhärenz, Konkordanz, Pharmazeutische Betreuung und Medikationsmanagement durchgeführt.

Hinweise für eine Verbesserung der Einnahmetreue liegen für folgende Prinzipien vor: individuelle Beratung des Patienten und der versorgenden Personen, Medikationsmanagement mit Vereinfachung des Einnahmeschemas und Einsatz von Fixkombinationen sowie Verwendung von Hilfsmitteln, wie z. B. dem individuellen Stellen der Arzneimittel. Die Wirksamkeit ist nur für die Dauer der Interventionen dokumentiert.

Die Verbesserung der Einnahmetreue ist ein Forschungsgebiet mit zunehmender Bedeutung für Morbidität und Kosten. Maßnahmen zur Verbesserung der Einnahmetreue sind ähnlich wichtig einzustufen wie die Erforschung neuer Wirkstoffe. Dennoch fehlen insbesondere für das deutsche Gesundheitssystem prospektive Studien mit klinischen Endpunkten, um evidenzbasierte Empfehlungen entwickeln zu können. Hier sind gemeinsame Anstrengungen von Ärzten und Apothekern erforderlich.

Abstract

Up to 50 % of patients with chronic diseases do not take their medication regularly. Poor adherence to drug therapy is associated with higher morbidity and mortality.

A selective literature search using the terms adherence, compliance, concordance, persistence, medication management, and pharmaceutical care was performed.

Evidence for improving adherence has been provided for the following principles: individual counselling of patients and care givers, medication management including simplifying dosing and use of combination tablets as well as the use of individual unit doses, e. g. blister cards. The effectiveness has only been shown for the duration of the interventions.

The improvement of medication adherence represents an area of research with high impact on outcomes and cost. Measures to improve adherence may be as important as the development of novel therapies. However, prospective clinical evaluations with clinical endpoints are missing especially for the German health care system in order to develop recommendations for clinical practice. Joint efforts of physicians and pharmacists are needed.

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Prof. Dr. med. Ulrich Laufs

Klinik für Innere Medizin III
Kardiologie, Angiologie und Internistische Intensivmedizin
Universitätsklinikum des Saarlandes

66421 Homburg/Saar

Phone: 06841/162-3436/-1331

Fax: 06841/162-1331

Email: ulrich@laufs.com