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Toivo T, Dimitrow M, Puustinen J, Savela E, Pelkonen K, Kiuru V, Suominen T, Kinnunen S, Uunimäki M, Kivelä SL, Leikola S, Airaksinen M. 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. BMC Geriatr 2018; 18:74. [PMID: 29548304 PMCID: PMC5857129 DOI: 10.1186/s12877-018-0737-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/29/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND 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. METHODS 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. DISCUSSION 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. TRIAL REGISTRATION The study is registered in the Clinical Trials.gov ( NCT02545257 ). Registration date September 9 2015.
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Affiliation(s)
- Terhi Toivo
- Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Viikinkaari 5 E, P.O. BOX 56, 00014 Helsinki, Finland
| | - Maarit Dimitrow
- Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Viikinkaari 5 E, P.O. BOX 56, 00014 Helsinki, Finland
| | - Juha Puustinen
- Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Viikinkaari 5 E, P.O. BOX 56, 00014 Helsinki, Finland
- Satakunta Hospital District, Satakunta Central Hospital, Unit of Neurology, Sairaalantie 3, 28500 Pori, Finland
| | - Eeva Savela
- 1st Pharmacy of Lohja, Laurinkatu 37-41 A, 08100 Lohja, Finland
| | | | - Valtteri Kiuru
- City of Lohja, Services for Aged Residents, PL 71, 08101 Lohja, Finland
| | - Tuula Suominen
- City of Lohja, Services for Aged Residents, PL 71, 08101 Lohja, Finland
| | - Sirkka Kinnunen
- City of Lohja, Services for Aged Residents, PL 71, 08101 Lohja, Finland
| | - Mira Uunimäki
- City of Lohja, Services for Aged Residents, PL 71, 08101 Lohja, Finland
| | - Sirkka-Liisa Kivelä
- Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Viikinkaari 5 E, P.O. BOX 56, 00014 Helsinki, Finland
- Institute of Clinical Medicine, Department of Family Medicine, University of Turku, 20014 Turku, Finland
| | - Saija Leikola
- 1st Pharmacy of Lohja, Laurinkatu 37-41 A, 08100 Lohja, Finland
| | - Marja Airaksinen
- Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Viikinkaari 5 E, P.O. BOX 56, 00014 Helsinki, Finland
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