Family doctor contract with AOK Baden-Württemberg: Over 4,000 fractures avoided thanks to medication that poses a lower risk of falls

04.07.2023 18:16

A study published at the end of May in the journal Age and Aging [1] shows that participants in family doctor-centered care (HZV) aged 65 and over had 4,160 fewer fall-related fractures - including femoral or pelvic fractures. The comparison was with insured people who received prescriptions for medications that could endanger falls, such as opioids. In the HZV group this was 24.8 percent of the participants (104,788), in the standard care comparison group 25.5 percent (54,005). According to the authors, the lower number of fall-related fractures in the HZV group is largely due to the lower number of prescriptions for fall-risking medications. In the 2020 study year, there were around 13,500 fewer prescriptions in the HZV group.

The study was carried out by scientists from the Department of General Medicine and Health Services Research at Heidelberg University Hospital. Their hypothesis was confirmed:
The researchers expected that there would be fewer prescriptions of fall-risking medications in the HZV group because the mandatory implementation of pharmacotherapy quality circles is a central component of the HZV. They take place four times a year under the leadership of trained moderators and make a significant contribution to significantly better medication supply. The topic of medications that pose a risk of falls was previously discussed in the quality circles. A large US study published in 2021 also shows how relevant medications that pose a risk of falls are². According to this, 94 percent of Americans over 65 received medications that increase the risk of falls. 20 years earlier it was only 57 percent, and the incidence of fall-related deaths had more than doubled.

Patients in usual care had a higher risk of falls

The methodology of the Heidelberg study is based on the aQua Institute's quality indicator system for outpatient care (QISA). The quality indicator 'Percentage of patients aged 65 and over who receive medications that pose a risk of falling' was developed there. In the study, these included opioids, tricyclic antidepressants, antipsychotics, hypnotics and sedatives. Medicines that could hardly be dispensed with, such as oral antidiabetics or antihypertensives, were not taken into account in the study. Professor Dr. Gunter Laux, lead scientist, explains the study: “First of all, it is noteworthy that for the first time falls and fractures in connection with pharmacotherapeutic care were scientifically examined by general practitioners in a special form of care. And the results clearly show that the patients in standard care had a higher risk of falling.” Fall-threatening medications obviously played an important role. In the HZV group their number is significantly lower and in standard care the dosage is even higher. “If we had also included the medicines that are hardly dispensable, as in the American study mentioned, then the number of fractures avoided in the cardiac arrest group would have been even significantly higher,” states Laux.

Improve the quality of primary care care by closely following evidence-based guidelines

The implementation of the participation in structured quality circles for drug therapy prescribed in Section 73b SGB V has an effect in the AOK-HZV contract. The goal is to continuously improve the quality of primary care care by closely following current evidence-based guidelines. In this regard, Prof. Dr. Nicola Buhlinger-Göpfarth, chairwoman of the Baden-Württemberg General Practitioners Association: “The results of the current study are remarkable, but not entirely surprising.
Our systematic training courses in over 350 data- and feedback-supported quality circles across the country have for years placed great emphasis on the aspect of patient safety, which is promoted by adequate medication therapy.”

Higher guideline orientation in HZV studies on pharmacotherapy demonstrated

The authors also point out that a higher level of guideline orientation in HZV has already been proven by other studies on pharmacotherapy. These include, for example, the higher average prescription rates for preparations that are of better or equal quality and are often more economical. The prescription rate for polymedication is also permanently lower than in standard care. The more targeted use of medicines is additionally supported by a module in the HZV contract software, through which suggestions for
rational pharmacotherapy should be proposed. The CEO of AOK Baden-Württemberg, Johannes Bauernfeind, sums up: “The combination of pharmacotherapy quality circles and drug module, which also includes our specialist contracts, makes a significant contribution to making drug treatment in the HZV both more medically appropriate and more economical is."

Sources:

1. Age and aging, Volume 52, Issue 5, May
2. Pharmacoepidemiology and Drug Safety, doi: 1002/pds.5201