Enhanced coordination of care to reduce medication risks in older home care clients in primary care: a randomized controlled trial

Autor: Maarit Dimitrow, Sirkka-Liisa Kivelä, Katariina Pelkonen, Mira Uunimäki, Valtteri Kiuru, Tuula Suominen, Terhi Toivo, Marja Airaksinen, Saija Leikola, Juha Puustinen, Eeva Savela
Přispěvatelé: Divisions of Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy, Helsinki One Health (HOH), Drug Research Program, Clin­ical Phar­macy Group, Faculty of Pharmacy, Division of Social Pharmacy
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Male
Psychological intervention
lcsh:Geriatrics
030226 pharmacology & pharmacy
law.invention
0302 clinical medicine
Randomized controlled trial
law
TOOL
Homes for the Aged
Drug Interactions
030212 general & internal medicine
Medication risk management
Potentially Inappropriate Medication List
Aged
80 and over
STATE
3. Good health
AGED GREATER-THAN-OR-EQUAL-TO-65 YEARS
317 Pharmacy
Older adults
Female
Patient Safety
INTERVENTIONS
Research Article
medicine.medical_specialty
Medication Therapy Management
Pharmacist
Home care
Medication safety
03 medical and health sciences
Patient safety
PEOPLE
Intervention (counseling)
medicine
MANAGEMENT
Humans
Medical prescription
Aged
Polypharmacy
Primary Health Care
business.industry
DRUG-RELATED PROBLEMS
Geriatricians
ADULTS
Triage
lcsh:RC952-954.6
Coordination of care
Family medicine
Geriatrics and Gerontology
business
Zdroj: BMC Geriatrics, Vol 19, Iss 1, Pp 1-13 (2019)
BMC Geriatrics
ISSN: 1471-2318
DOI: 10.1186/s12877-019-1353-2
Popis: Background As populations are aging, a growing number of home care clients are frail and use multiple, complex medications. Combined with the lack of coordination of care this may pose uncontrolled polypharmacy and potential patient safety risks. The aim of this study was to assess the impact of a care coordination intervention on medication risks identified in drug regimens of older home care clients over a one-year period. Methods Two-arm, parallel, cluster randomized controlled trial with baseline and follow-up assessment at 12 months. The study was conducted in Primary Care in Lohja, Finland: all 5 home care units, the public healthcare center, and a private community pharmacy. Participants: All consented home care clients aged > 65 years, using at least one prescription medicine who were assessed at baseline and at 12 months. Intervention: Practical nurses were trained to make the preliminary medication risk assessment during home visits and report findings to the coordinating pharmacist. The coordinating pharmacist prepared the cases for the triage meeting with the physician and home care nurse to decide on further actions. Each patient’s physician made the final decisions on medication changes needed. Outcomes were measured as changes in medication risks: use of potentially inappropriate medications and psychotropics; anticholinergic and serotonergic load; drug-drug interactions. Results Participants (n = 129) characteristics: mean age 82.8 years, female 69.8%, mean number of prescription medicines in use 13.1. The intervention did not show an impact on the medication risks between the original intervention group and the control group in the intention to treat analysis, but the per protocol analysis indicated tendency for effectiveness, particularly in optimizing central nervous system medication use. Half (50.0%) of the participants with a potential need for medication changes, agreed on in the triage meeting, had none of the medication changes actually implemented. Conclusion The care coordination intervention used in this study indicated tendency for effectiveness when implemented as planned. Even though the outcome of the intervention was not optimal, the value of this paper is in discussing the real world experiences and challenges of implementing new practices in home care. Trial registration ClinicalTrials.gov (NCT02545257). Registered September 9 2015.
Databáze: OpenAIRE
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