The Finnish Interprofessional Medication Assessment (FIMA): baseline findings from home care setting.
Aged
Geriatric assessment
Home care
Interdisciplinary health team
Medicines
Older people
Journal
Aging clinical and experimental research
ISSN: 1720-8319
Titre abrégé: Aging Clin Exp Res
Pays: Germany
ID NLM: 101132995
Informations de publication
Date de publication:
Oct 2019
Oct 2019
Historique:
received:
30
08
2018
accepted:
21
11
2018
pubmed:
7
12
2018
medline:
19
11
2019
entrez:
7
12
2018
Statut:
ppublish
Résumé
Medication-related problems and declined functional capacity are closely associated factors among older people. The purpose of this study is to describe the procedure of interprofessional medication assessment in home care context and the baseline characteristics of the study population. The FIMA study was a randomized, controlled intervention study comparing general practitioner-led interprofessional medication assessment and usual care. Patients' chronic diagnoses and medication use as well as physical and cognitive functions were investigated. Performance in daily activities, use of care services and help from family and relatives, self-rated health and health-related quality of life, and adverse effects commonly related to medication were assessed. The home care patients (n = 512) had significant disease burden and functional limitations. The mean number of all medicines was 15 and that of regularly taken medicines 10. The majority of patients (87%) had excessive polypharmacy. The most commonly used (97%) ATC medicine class was nervous system medicines. Clinically relevant (class C or D SFINX record) drug-drug interactions were seen in 74% of the patients. The most frequent risks of adverse effects were risk of bleeding (66%), constipation (58%) and orthostatism (54%) occurring in over half of the patients. Medicines affecting renal function were used by 85% of the patients. There is an evident need and justification for medication assessments in home care. In most cases, home care patients fulfill the criteria for regular medication assessments.
Identifiants
pubmed: 30519976
doi: 10.1007/s40520-018-1085-8
pii: 10.1007/s40520-018-1085-8
pmc: PMC6763522
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
1471-1479Subventions
Organisme : Etelä-Savon Rahasto
ID : 12172075
Références
Official Statistics of Finland (OSF). Population projection. Statistics Finland, Helsinki. http://www.stat.fi/til/vaenn/2015/ . Accessed 24 May 2018
Davies R (2018) Older people in Europe—EU Policies and programmes. European Parlamentary Research Service 2014. http://www.europarl.europa.eu/RegData/bibliotheque/briefing/2014/140811/LDM_BRI(2014)140811_REV1_EN.pdf . Accessed May 24 2018
Age UK (2018) Briefing: Health and Care of Older People in England 2017. https://www.ageuk.org.uk/Documents/EN-GB/For-professionals/Research/The_Health_and_Care_of_Older_People_in_England_2016.pdf?dtrk=true . Accessed 24 May 2018
Koskinen S, Lundqvist A, Ristiluoma N (2012) Health, functional capacity and welfare in Finland in 2011. National Institute for Health and Welfare (THL), Report 68/2012. Helsinki 2012
Shi S, Morike K, Klotz U (2008) The clinical implications of ageing for rational drug therapy. Eur J Clin Pharmacol 64:183–199
doi: 10.1007/s00228-007-0422-1
Johansson T, Abuzahra ME, Keller S et al (2016) Impact of strategies to reduce polypharmacy on clinically relevant endpoints: a systematic review and meta-analysis. Br J Clin Pharmacol 82:532–548
doi: 10.1111/bcp.12959
Maher RL, Hanlon J, Hajjar ER (2014) Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf 13:57–65
doi: 10.1517/14740338.2013.827660
Gurwitz JH, Field TS, Harrold LR (2003) Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA 289:1107–1116
doi: 10.1001/jama.289.9.1107
Fialova D, Topinkova E, Gambassi G et al (2005) Potentially inappropriate medication use among elderly home care patients in Europe. JAMA 293:1348–1358
doi: 10.1001/jama.293.11.1348
Patterson Susan M, Cadogan Cathal A, Kerse N et al (2014) Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD008165.pub3
doi: 10.1002/14651858.CD008165.pub3
pubmed: 25288041
Lenander C, Elfsson B, Danielsson B et al (2014) Effects of a pharmacist-led structured medication review in primary care on drug-related problems and hospital admission rates: a randomized controlled trial. Scand J Prim Health Care 32:180–186
doi: 10.3109/02813432.2014.972062
Petri L (2010) Concept analysis of interdisciplinary collaboration. Nurs Forum 45:73–82
doi: 10.1111/j.1744-6198.2010.00167.x
Merikoski M, Jyrkkä J, Auvinen K et al (2017) The finnish interprofessional medication assessment (FIMA). Effects on mediation, functional capacity, quality of life and use of health and home care services in home care patients. Rep Memo Minist Soc Aff Health 2017:34
Kallio S, Kumpusalo-Vauhkonen A, Jarvensivu T et al (2016) Towards interprofessional networking in medication management of the aged: current challenges and potential solutions in Finland. Scand J Prim Health Care 34:368–376
doi: 10.1080/02813432.2016.1249055
Bischoff HA, Stähelin HB, Monsch AU et al (2003) Identifying a cut-off point for normal mobility: a comparison of the timed ‘up and go’test in community-dwelling and institutionalised elderly women. Age Ageing 32:315–320
doi: 10.1093/ageing/32.3.315
Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383
doi: 10.1016/0021-9681(87)90171-8
Katz S, Ford AB, Moskowitz RW et al (1963) Studies of illness in the aged. The index of Adl: a standardized measure of biological and psychosocial function. JAMA 185:914–919
doi: 10.1001/jama.1963.03060120024016
Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186
doi: 10.1093/geront/9.3_Part_1.179
Wallace M, Shelkey M (2008) Monitoring functional status in hospitalized older adults. Am J Nurs 108:64–71
doi: 10.1097/01.NAJ.0000314811.46029.3d
Shumway-Cook A, Brauer S, Woollacott M (2000) Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther 80:896–903
pubmed: 10960937
Barry E, Galvin R, Keogh C et al (2014) Is the timed up and go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis. BMC Geriatr 14:14
doi: 10.1186/1471-2318-14-14
Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198
doi: 10.1016/0022-3956(75)90026-6
Ylikoski R, Erkinjuntti T, Sulkava R et al (1992) Correction for age, education and other demographic variables in the use of the mini mental state examination in Finland. Acta Neurol Scand 85:391–396
doi: 10.1111/j.1600-0404.1992.tb06034.x
Yesavage JA, Brink TL, Rose TL et al (1982) Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 17:37–49
doi: 10.1016/0022-3956(82)90033-4
Smarr KL, Keefer AL (2011) Measures of depression and depressive symptoms: beck depression inventory-II (BDI-II), center for epidemiologic studies depression scale (CES-D), geriatric depression scale (GDS), hospital anxiety and depression scale (HADS), and patient health questionnaire-9 (PHQ-9). Arthritis Care Res (Hoboken) 63:S454–S466
doi: 10.1002/acr.20556
Ohinmaa A, Sintonen H (1998) Inconsistencies and modelling of the Finnish EuroQol (EQ-5D) preference values. In: Greiner W, Schulenburg J-M Gvd et al. (eds) EQ plenary meeting, Hannover, 1–2 Oct 1998. Discussion papers. ISBN3-932152-32-8, pp 57–74
Szende A, Oppe M, Devlin N (2007) EQ-5D value sets: inventory, comparative review and user guide. Springer Science & Business Media, Berlin
doi: 10.1007/1-4020-5511-0
Rabin R, de Charro F (2001) EQ-5D: a measure of health status from the EuroQol Group. Ann Med 33:337–343
doi: 10.3109/07853890109002087
Low PA, Tomalia VA (2015) Orthostatic hypotension: mechanisms, causes, management. J Clin Neurol 11:220–226
doi: 10.3988/jcn.2015.11.3.220
The Consensus Committee of the American Autonomic Society and the American Academy of Neurology (1996) Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. Neurology 46:1470
doi: 10.1212/WNL.46.5.1470
Matsushita K, Mahmoodi BK, Woodward M et al (2012) Chronic kidney disease prognosis consortium: comparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate. JAMA 307:1941–1951
doi: 10.1001/jama.2012.3954
WHO Collaborating Centre for Drug Statistics Methodology (2017) Guidelines for ATC classification and DDD assignment 2018. Oslo
Medbase. http://www.medbase.fi/en/professionals . Accessed 12 Feb 2017
Saarni SI, Härkänen T, Sintonen H et al (2006) The impact of 29 chronic conditions on health-related quality of life: a general population survey in Finland using 15D and EQ-5D. Qual Life Res 15:1403–1414
doi: 10.1007/s11136-006-0020-1
Vartiainen P, Mantyselka P, Heiskanen T et al (2017) Validation of EQ-5D and 15D in the assessment of health-related quality of life in chronic pain. Pain 158:1577–1585
doi: 10.1097/j.pain.0000000000000954
Jyrkka J, Vartiainen L, Hartikainen S et al (2006) Increasing use of medicines in elderly persons: a five-year follow-up of the Kuopio 75 + Study. Eur J Clin Pharmacol 62:151–158
doi: 10.1007/s00228-005-0079-6
Teramura-Gronblad M, Raivio M, Savikko N et al (2016) Potentially severe drug-drug interactions among older people and associations in assisted living facilities in Finland: a cross-sectional study. Scand J Prim Health Care 34:250–257
doi: 10.1080/02813432.2016.1207142
Sanchez-Fidalgo S, Guzman-Ramos MI, Galvan-Banqueri M et al (2017) Prevalence of drug interactions in elderly patients with multimorbidity in primary care. Int J Clin Pharm 39:343–353
doi: 10.1007/s11096-017-0439-1
Hosia-Randell HM, Muurinen SM, Pitkälä KH (2008) Exposure to potentially inappropriate drugs and drug-drug interactions in elderly nursing home residents in Helsinki, Finland. Drugs Aging 25:683–692
doi: 10.2165/00002512-200825080-00005
Johnell K (2015) Inappropriate drug use in people with cognitive impairment and dementia: a systematic review. Curr Clin Pharmacol 10:178–184
doi: 10.2174/1574884710666150609154741
Jyrkkä J (2011) Drug use and polypharmacy in elderly persons. Publications of the University of Eastern Finland. Dissertations in Health Sciences 47. Kuopio, http://urn.fi/URN:ISBN:978-952-61-0385-3 . Accessed 25 May 2018
American Geriatrics Society, Society G, American academy of, orthopaedic surgeons panel on falls prevention. Guideline for the prevention of falls in older persons. J Am Geriatr Soc 2001; 49:664–672
doi: 10.1046/j.1532-5415.2001.49115.x
Low PA (2008) Prevalence of orthostatic hypotension. Clin Auton Res 18:8–13
doi: 10.1007/s10286-007-1001-3
Poon IO, Braun U (2005) High prevalence of orthostatic hypotension and its correlation with potentially causative medications among elderly veterans. J Clin Pharm Ther 30:173–178
doi: 10.1111/j.1365-2710.2005.00629.x
Dörks M, Allers K, Schmiemann G et al (2017) Inappropriate medication in non-hospitalized patients with renal insufficiency: a systematic review. J Am Geriatr Soc 65:853–862
doi: 10.1111/jgs.14809
Nielsen AL, Henriksen DP, Marinakis C et al (2014) Drug dosing in patients with renal insufficiency in a hospital setting using electronic prescribing and automated reporting of estimated glomerular filtration rate. Basic Clin Pharmacol Toxicol 114:407–413
doi: 10.1111/bcpt.12185
Messerli M, Blozik E, Vriends N et al (2016) Impact of a community pharmacist-led medication review on medicines use in patients on polypharmacy—a prospective randomised controlled trial. BMC Health Serv Res. https://doi.org/10.1186/s12913-016-1384-8
doi: 10.1186/s12913-016-1384-8
pubmed: 27108410
pmcid: 4842295
Mekonnen AB, McLachlan AJ, Brien JA (2016) Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: a systematic review and meta-analysis. BMJ Open 6:e010003
doi: 10.1136/bmjopen-2015-010003
Leikola S, Tuomainen L, Peura S et al (2012) Comprehensive medication review: development of a collaborative procedure. Int J Clin Pharm 34:510–514
doi: 10.1007/s11096-012-9662-y