Development of a Coordinated, Community-Based Medication Management Model for Home-Dwelling Aged in Primary Care
Study Details
Study Description
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.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
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.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: Active comparator In addition to normal, standard care, participants allocated to intervention group will receive a coordinated medication management model containing prescription review, drug-related problems (DRP) risk assessment and required action based on the DRP risk assessment. |
Other: Coordinated 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
|
| No Intervention: Control group (standard care) Normal, standard care (control group) |
Outcome Measures
Primary Outcome Measures
- 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]
- 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]
- 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).
Secondary Outcome Measures
- Use of health care services: visits to physician [at 12 and 24 months from baseline]
Number of visits (previous 3 months)
- 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)
Eligibility Criteria
Criteria
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
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | 1st Pharmacy of Lohja | Lohja | Finland | 08100 | |
| 2 | Services for aged people | Lohja | Finland | 08100 |
Sponsors and Collaborators
- University of Helsinki
- City of Lohja, Services for Aged People
- Lohjan 1. Apteekki
- Social Insurance Institution, Finland
Investigators
- Study Chair: Marja SA Airaksinen, Professor, University of Helsinki
- Study Director: Juha T Puustinen, Docent, University of Helsinki
Study Documents (Full-Text)
None provided.More Information
Additional Information:
- Leikola S. Development and Application of Comprehensive Medication Review Procedure to Community-Dwelling Elderly. Doctoral Thesis, University of Helsinki, 2012
- Puustinen J. Benzodiazepines and Cognitive Functioning in Older Adults. With Emphasis on Long-Term Use and Withdrawal. Doctoral Thesis, University of Turku, 2014
Publications
None provided.- 153/13/03/00/2015