Drug Therapy, Combination, Inappropriate Prescribing, Polypharmacy
Conditions
Keywords
Aged people, Home care, Drug related problems, DRPs, Coordinated medication management model
Brief summary
The objective of this randomized controlled trial is to develop a coordinated, multiprofessional medication management model for home-dwelling aged in primary care and to study the effectiveness of this model. The main hypothesis is that the new model helps to identify aged people having potential risks with their medications and thus allows solving these risks.
Detailed description
The demand for long-term home health care services is increasing due the demographic and societal developments. Aged people needing home care are increasingly older, have many chronic diseases and use multiple medicines and thus, are at high risk for drug-related problems (DRPs). In Finland, national and local healthcare and aged care strategies target to allowing aged people (over 65 years) living in their own homes as long as possible. This minimizes the costs of institutionalized care and also targets to add the quality of life of aged people. New approaches and service models are needed to meet these challenges. The present study focuses on the development of a coordinated medication management model which aims to ensure the safe medication practises for home-dwelling aged in primary care. In the previous parts of this study project were developed a model for comprehensive medication review process (CMR) and a Drug-Related Problem Risk Assessment Tool. The present study uses a multistage intervention in which medications are reviewed (prescription review) in a community pharmacy using the SFINX-database to identify clinically significant drug-drug interactions and the Salko-database which identifies potentially inappropriate medications for aged people. In the next stage practical nurses use the Drug-Related Problem Risk Assessment Tool to identify potential risks. The following stages are based on the results from the risk assessment tool. Potential options are, e.g.,physician consultation, more frequent home care visits, counselling given by the community pharmacy or comprehensive medication review (CMR). The CMR process is only targeted to a limited group of study participants with clinically significant DRP who probably will benefit from more comprehensive CMR.
Interventions
OTHERCoordinated medication management model
Stage I: a prescription review conducted by community pharmacists Stage II: practical nurse-administered Drug-related Problem Risk Assessment Tool Stage III: Required health care action based on the result of the DRP -Risk Assessment Tool
Sponsors
City of Lohja, Services for Aged People
Lohjan 1. Apteekki
Social Insurance Institution, Finland
University of Helsinki
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Home-dwelling over 65 year-old persons receiving regular home care from the City of Lohja
Exclusion criteria
* Home care is not given regularly
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Potentially inappropriate medicines (PIM) (Clinically significant drug-drug interactions, potentially inappropriate medicines for aged), identified from medication list review chart | Change from baseline at 12 and 24 months | PIMs are identified with prescription review using SFINX database (clinically significant drug-drug interactions) and Salko database (e.g., for identifying potentially inappropriate medicines for the aged, anticholinergic and serotonergic load). |
| AUDIT-C (Alcohol Use Disorder Identification Test, version C) | Change from baseline at 12 and 24 months | — |
| UDI-6 (Urinary Distress Inventory) | Change from baseline at 12 and 24 months | — |
| Rava (Functioning and disability, Finnish Consulting Group) | Change from baseline at 12 and 24 months | — |
| GDS-15 (Geriatric Depression Scale) | Change from baseline at 12 and 24 months | — |
| MMSE (Mini-Mental State Examination) | Change from baseline at 12 and 24 months | Cognitive ability |
| MNA (Malnutrition Assessment) | Change from baseline at 12 and 24 months | — |
| Time to rise from a chair and return to the seated position 5 times (Lower extremity function). | Change from baseline at 12 and 24 months | — |
| Orthostatic hypotension (Short test, Freeman et al. 2011) | Change from baseline at 12 and 24 months | — |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Use of health care services: hospital days | at 12 and 24 months from baseline | Number of hospital days (previous 3 months) |
| Use of health care services: home care services | at 12 and 24 months from baseline | Services delivered to home (previous 3 months) |
| Use of health care services: visits to physician | at 12 and 24 months from baseline | Number of visits (previous 3 months) |
Countries
Finland
Outcome results
None listed