Coordinating resources for prospective medication risk management of older home care clients in primary care: procedure development and RCT study design for demonstrating its effectiveness

Autor: Valtteri Kiuru, Sirkka Kinnunen, Saija Leikola, Maarit Dimitrow, Eeva Savela, Katariina Pelkonen, Sirkka-Liisa Kivelä, Juha Puustinen, Terhi Toivo, Marja Airaksinen, Mira Uunimäki, Tuula Suominen
Přispěvatelé: Faculty of Pharmacy, Clin­ical Phar­macy Group, Division of Pharmacology and Pharmacotherapy, Drug Research Program
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
Psychological intervention
lcsh:Geriatrics
Pharmacists
030226 pharmacology & pharmacy
law.invention
Study Protocol
0302 clinical medicine
Randomized controlled trial
law
Health care
CRITERIA
030212 general & internal medicine
Prospective Studies
Medication risk management
Action research
Risk management
Finland
Home Care Services
STATE
3. Good health
Treatment Outcome
317 Pharmacy
Older adults
Health Resources
Female
Medical emergency
FEASIBILITY
DATABASE
Home care
03 medical and health sciences
Medication Reconciliation
PEOPLE
medicine
Humans
Aged
Risk Management
Primary Health Care
business.industry
MORTALITY
Clinical study design
DRUG-RELATED PROBLEMS
ADULTS
ONLINE SURVEILLANCE SYSTEM
medicine.disease
Triage
Clinical pharmacy
lcsh:RC952-954.6
Coordinated procedure
HEALTH-CARE
Geriatrics and Gerontology
business
Zdroj: BMC Geriatrics, Vol 18, Iss 1, Pp 1-10 (2018)
BMC Geriatrics
ISSN: 1471-2318
DOI: 10.1186/s12877-018-0737-z
Popis: The magnitude of safety risks related to medications of the older adults has been evidenced by numerous studies, but less is known of how to manage and prevent these risks in different health care settings. The aim of this study was to coordinate resources for prospective medication risk management of home care clients ≥ 65 years in primary care and to develop a study design for demonstrating effectiveness of the procedure. Health care units involved in the study are from primary care in Lohja, Southern Finland: home care (191 consented clients), the public healthcare center, and a private community pharmacy. System based risk management theory and action research method was applied to construct the collaborative procedure utilizing each profession’s existing resources in medication risk management of older home care clients. An inventory of clinical measures in usual clinical practice and systematic review of rigorous study designs was utilized in effectiveness study design. The new coordinated medication management model (CoMM) has the following 5 stages: 1) practical nurses are trained to identify clinically significant drug-related problems (DRPs) during home visits and report those to the clinical pharmacist. Clinical pharmacist prepares the cases for 2) an interprofessional triage meeting (50–70 cases/meeting of 2 h) where decisions are made on further action, e.g., more detailed medication reviews, 3) community pharmacists conduct necessary medication reviews and each patients’ physician makes final decisions on medication changes needed. The final stages concern 4) implementation and 5) follow-up of medication changes. Randomized controlled trial (RCT) was developed to demonstrate the effectiveness of the procedure. The developed procedure is feasible for screening and reviewing medications of a high number of older home care clients to identify clients with severe DRPs and provide interventions to solve them utilizing existing primary care resources. The study is registered in the Clinical Trials.gov ( NCT02545257 ). Registration date September 9 2015.
Databáze: OpenAIRE
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