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

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...

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Autores principales: Toivo, Terhi, Airaksinen, Marja, Dimitrow, Maarit, Savela, Eeva, Pelkonen, Katariina, Kiuru, Valtteri, Suominen, Tuula, Uunimäki, Mira, Kivelä, Sirkka-Liisa, Leikola, Saija, Puustinen, Juha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882364/
https://www.ncbi.nlm.nih.gov/pubmed/31775650
http://dx.doi.org/10.1186/s12877-019-1353-2
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author Toivo, Terhi
Airaksinen, Marja
Dimitrow, Maarit
Savela, Eeva
Pelkonen, Katariina
Kiuru, Valtteri
Suominen, Tuula
Uunimäki, Mira
Kivelä, Sirkka-Liisa
Leikola, Saija
Puustinen, Juha
author_facet Toivo, Terhi
Airaksinen, Marja
Dimitrow, Maarit
Savela, Eeva
Pelkonen, Katariina
Kiuru, Valtteri
Suominen, Tuula
Uunimäki, Mira
Kivelä, Sirkka-Liisa
Leikola, Saija
Puustinen, Juha
author_sort Toivo, Terhi
collection PubMed
description 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.
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spelling pubmed-68823642019-12-03 Enhanced coordination of care to reduce medication risks in older home care clients in primary care: a randomized controlled trial Toivo, Terhi Airaksinen, Marja Dimitrow, Maarit Savela, Eeva Pelkonen, Katariina Kiuru, Valtteri Suominen, Tuula Uunimäki, Mira Kivelä, Sirkka-Liisa Leikola, Saija Puustinen, Juha BMC Geriatr Research Article 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. BioMed Central 2019-11-27 /pmc/articles/PMC6882364/ /pubmed/31775650 http://dx.doi.org/10.1186/s12877-019-1353-2 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Toivo, Terhi
Airaksinen, Marja
Dimitrow, Maarit
Savela, Eeva
Pelkonen, Katariina
Kiuru, Valtteri
Suominen, Tuula
Uunimäki, Mira
Kivelä, Sirkka-Liisa
Leikola, Saija
Puustinen, Juha
Enhanced coordination of care to reduce medication risks in older home care clients in primary care: a randomized controlled trial
title Enhanced coordination of care to reduce medication risks in older home care clients in primary care: a randomized controlled trial
title_full Enhanced coordination of care to reduce medication risks in older home care clients in primary care: a randomized controlled trial
title_fullStr Enhanced coordination of care to reduce medication risks in older home care clients in primary care: a randomized controlled trial
title_full_unstemmed Enhanced coordination of care to reduce medication risks in older home care clients in primary care: a randomized controlled trial
title_short Enhanced coordination of care to reduce medication risks in older home care clients in primary care: a randomized controlled trial
title_sort enhanced coordination of care to reduce medication risks in older home care clients in primary care: a randomized controlled trial
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882364/
https://www.ncbi.nlm.nih.gov/pubmed/31775650
http://dx.doi.org/10.1186/s12877-019-1353-2
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