Changes in prescription patterns in older hospitalized patients: the impact of FORTA on disease-related over- and under-treatments

Pazan, Farhad; Burkhardt, Heinrich; Frohnhofen, Helmut; Weiß, Christel; Throm, Christina; Kuhn-Thiel, Alexandra; Wehling, Martin

doi:10.1007/s00228-017-2383-3

Cited by 19 publications

(13 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The VALFORTA trial was the first larger RCT on a listing approach to yield in the improvement of relevant clinical endpoints such as activities of daily living or the occurrence of adverse drug reactions; the number needed to treat for latter effect was only 5, meaning that one side effect was gone after treating only 5 patients according to FORTA. Moreover, secondary analyses of the VALFORTA trial revealed that the application of FORTA also significantly improved the medication quality at the diagnosis-related, individual drug/drug class level and that higher FORTA scores are associated with worse functional outcomes [13,14]. This study did not only demonstrate the clinical effectiveness of FORTA but also its teachability, implementability and, thus, utility in a clinical setting.…”

Section: Clinical Validation Of Fortamentioning

confidence: 65%

The Fit fOR The Aged (FORTA) project and its clinical implications

Pazan

Wehling

2020

Expert Opinion on Drug Metabolism & Toxicology

Self Cite

View full text Add to dashboard Cite

Section: Clinical Validation Of Fortamentioning

confidence: 65%

The Fit fOR The Aged (FORTA) project and its clinical implications

Pazan

Wehling

2020

Expert Opinion on Drug Metabolism & Toxicology

Self Cite

View full text Add to dashboard Cite

“…Reducing the dose or discontinuing Ach medicines are some of the awareness and implementation protocols currently being executed by clinical pharmacists (32–34). Other tools and measures are also being investigated to improve medication use among elderly patients in various settings (35–37). From the perspective of healthcare practitioners, drug developers, and regulators, establishing a common ground of understanding regarding pertinent information about older people for rational prescribing may still be lacking, and further collaboration among these stakeholders is highly recommended to improve prescribing in this population (38).…”

Section: Discussionmentioning

confidence: 99%

The Use of Medicines with Anti-cholinergic Properties and Their Health Impacts among Hospitalised Malaysian Geriatric Patients

Wahab

Akbar

Zainal

et al. 2019

MJMS

View full text Add to dashboard Cite

Background Studies have shown that the use of medicines with anti-cholinergic (Ach) properties can increase elderly patients’ risk of experiencing falls, confusion, and longer hospital stays (LOS). These adverse effects are preventable with appropriate intervention. Little is known about the use of medicines with Ach properties and their impact on Malaysian elderly patients. This study aimed to investigate the use of medicines with Ach properties and their impact on fall risk, confusion, and longer LOS among hospitalised elderly patients. Methods This study utilised a cross-sectional design and was conducted at a single centre where convenience sampling was employed to collect data from elderly patients (> 60 years) admitted to geriatric and medical wards at Hospital Tuanku Ja’afar during a 2-month period (July 2017–August 2017). Patients were excluded from this study if their hospital admission was planned for an elective procedure or if neurocognitive and hepatic impairment were diagnosed prior to the hospital admission. Medicines with Ach properties were identified and classified according to the anti-cholinergic drug scale (ADS). Univariate and multiple logistic regression statistical analyses were performed to assess its impacts on falls, confusion, and LOS. Results A total of 145 elderly patients with a mean age of 71.59 years old (SD = 8.02) were included in the study. Fifty-two percent of the participants were female, and the average hospital stay was 6 days (SD = 2.09). Medicines with Ach properties were administered in 62% ( n = 90) of the cases. The most commonly prescribed medicine with Ach properties was furosemide ( n = 59), followed by ranitidine ( n = 44), warfarin ( n = 23), and methylprednisolone ( n = 22). Compared to patients who did not receive medicines with Ach properties, patients who received them had a significantly higher risk of falls [odds ratios (OR) = 2.61; 95%CI: 1.18, 5.78; P = 0.018], confusion (OR = 3.60; 95%CI: 1.55, 8.36; P = 0.003), and LOS (OR = 4.83; 95%CI: 2.13, 10.94; P < 0.001). Multiple comorbidities also showed a significantly increased risk of falls (OR = 3.03; 95%CI: 1.29, 7.07; P = 0.010). Conclusion Medicines with Ach properties had a significant impact on elderly patients’ health. Strategies for rationally prescribing medicines with Ach properties to Malaysian elderly patients need to be improved and be recognised as an important public health priority.

show abstract

“…Die FORTA-Liste hat in randomisierten klinischen Studien bereits positive Effekte bei Anwendung gezeigt [55,61]. Unter anderem können Über-und Unterbehandlungen anhand der Liste detektiert werden [62].…”

Section: Arzneimittelinteraktionenunclassified

Optimierung der Psychopharmakotherapie im Alter

Hefner

2020

Klinikarzt

View full text Add to dashboard Cite

ZUSAMMENFASSUNGDas Medikamenten-Management wird bei Alterspatienten erschwert u. a. durch Gebrechlichkeit und Multimorbidität, Polypharmazie und Arzneimittelinteraktionen, Non-Adhärenz und die Veränderung pharmakodynamischer und pharmakokinetischer Parameter. Trotz erhöhter Arzneistoff-Blutspiegel im Vergleich mit jüngeren Patienten und einer gesteigerten Rezeptorsensitivität sollten jedoch nicht alle Alterspatienten per se nach dem Dictum „start low, go slow“ therapiert werden, um das Risiko einer Unterdosierung zu vermeiden. Jeder Alterspatient besitzt einen individuellen komplexen pharmakokinetischen und pharmakodynamischen Phänotyp, beeinflusst von multiplen Variablen. Therapeutisches Drug Monitoring (TDM) kann bei einer Psychopharmakotherapie helfen, den individuellen pharmakokinetischen Status und auch Non-Adhärenz zu erkennen, um die maximale effektive und verträgliche Dosis zu finden. Die Erfassung des pharmakodynamischen Status muss individuell klinisch erfolgen. Verschiedene Interventionen wurden erfolgreich entwickelt, um die Medikation bei Alterspatienten zu optimieren.

show abstract

Changes in prescription patterns in older hospitalized patients: the impact of FORTA on disease-related over- and under-treatments

Cited by 19 publications

References 28 publications

The Fit fOR The Aged (FORTA) project and its clinical implications

The Fit fOR The Aged (FORTA) project and its clinical implications

The Use of Medicines with Anti-cholinergic Properties and Their Health Impacts among Hospitalised Malaysian Geriatric Patients

Optimierung der Psychopharmakotherapie im Alter

Contact Info

Product

Resources

About