The Finnish Interprofessional Medication Assessment (FIMA): baseline findings from home care setting

Auvinen, Kati Johanna; Räisänen, Johanna; Merikoski, Merja; Mäntylä, Antti; Kumpusalo-Vauhkonen, Anne; Enlund, Hannes; Liukkonen, Tuula A.; Jyrkkä, Johanna; Lönnroos, Eija; Mäntyselkä, Pekka

doi:10.1007/s40520-018-1085-8

Cited by 14 publications

(23 citation statements)

References 41 publications

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“…However, it should be noted that the interaction database used was different, and therefore, the classification of interactions may not be equivalent. Clinically relevant interactions using the SFINX‐PHARAO ® database were found in 74% of the home care patients in a study conducted in Finland by Auvinen et al, though the patients used more drugs and were older and more fragile than in our study. In the present study, the frequency of interactions to be best avoided (class D interactions) was slightly higher among persons with diabetes (7.1%) whereas the frequency among persons without diabetes (5.1%) was similar to the study conducted by Hosia‐Randell et al, which studied DDIs among nursing home residents (4.8%).…”

Section: Resultscontrasting

confidence: 65%

Clinically relevant drug‐drug interactions and the risk for drug adverse effects among home‐dwelling older persons with and without type 2 diabetes

et al. 2019

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What is known and objective Polypharmacy and age are known to increase the risk for potential drug interactions. Type 2 diabetes has been associated with polypharmacy and several comorbidities. Currently, there is no information on whether the frequency of clinically relevant drug‐drug interactions and the risk for drug adverse effects differ between older persons with and without diabetes. The aim of this study was to investigate the frequency of drug‐drug interactions and the risk for drug adverse effects in these two groups in primary care. Methods The basic study population consisted of Finnish home‐dwelling primary care patients aged ≥ 65 years (N = 3039). For each person with diabetes, two controls were selected with adjusted age and gender. To collect data, electronic primary care patient records, a structured health questionnaire and a structured health examination conducted by a physician were utilized. Using the SFINX‐PHARAO® database, drug‐drug interactions and the risk for drug adverse effects were evaluated in 182 persons with type 2 diabetes and 176 persons without diabetes. Results and discussion There were no significant differences in the frequency of drug‐drug interactions or the risk for drug adverse effects in persons with and without diabetes. At least one clinically relevant interaction was found in 81 (44.5%) persons with diabetes and 73 (41.5%) persons without diabetes. The most common drugs causing interactions included non‐steroidal anti‐inflammatory drugs (NSAIDs) and warfarin. What is new and conclusion There is no difference in the frequency of drug‐drug interactions or risk for drug adverse effects in older home‐dwelling persons with and without diabetes. Due to common comorbidities and commonly used drugs among persons with diabetes, drug‐drug interactions involving warfarin or NSAIDs in particular should be carefully monitored to avoid drug adverse effects.

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Section: Resultscontrasting

confidence: 65%

Clinically relevant drug‐drug interactions and the risk for drug adverse effects among home‐dwelling older persons with and without type 2 diabetes

et al. 2019

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“…A total of 512 patients were recruited by home care nurses from February to December 2015 ( Figure 1). The characteristics of the participants have been described previously [11]. Written informed consent was obtained from all individual patients included in the study or their closest proxy if the patient had cognitive impairments.…”

Section: Study Design and Participantsmentioning

confidence: 99%

“…An interprofessional team approach has been suggested as a solution to promote the rational medicine use among older people [10]. The Finnish Interprofessional Medication Assessment (FIMA) is a general practitioner (GP) led, repeatable and practice-based model for medication optimization of older people [11]. The FIMA model was developed for home care settings.…”

Section: Introductionmentioning

confidence: 99%

Interprofessional medication assessment among home care patients: Any impact on functioning? Results from a randomised controlled trial

Auvinen¹,

Voutilainen

Jyrkkä

et al. 2020

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BackgroundMultimorbidity and polypharmacy are related to the use of potentially inappropriate medicines and negative clinical outcomes including drug-related adverse events and functional declines. Home care clients are a vulnerable patient group often exposed to these risks. The aim of this study was to examine whether an interprofessional medication assessment can influence the functioning of home care patients.MethodsThe FIMA study was a randomised controlled intervention study comparing a general practitioner-led interprofessional medication assessment conducted at the baseline of the study with usual care with a six-month follow-up. We used linear mixed models (LMM) with a random subject effect to detect differences between the usual care and intervention groups in the following outcome measures; Katz index of Activities of Daily Living (ADL), Lawton and Brody scale of Instrumental Activities of Daily Living, Timed up and go-test (TUG), Mini-Mental State Examination, Geriatric Depression Scale and the 3-level version of EQ-5D.ResultsHome care patients (n= 512) had major disease burdens and functional limitations. Regarding TUG times, the LMM detected a one second improvement in the FIMA group and 2.4 seconds worsening in the usual care group. However, the result was not statistically significant. The ADL revealed an interaction across time, treatment and gender (p=0.026). The ADL score decreased in both groups; the decline being the steepest among women in the intervention group.ConclusionsIn general, medication assessments may have limited impact on functioning of older people. Nonetheless, the FIMA intervention may prevent worsening of mobility among older home care patients.Trial registrationThe Interprofessional Medication Assessment for Older Patients, Clinical Trials.gov. NCT02398812. First registration, 26 March 2015. Retrospectively registered. https://www.clinicaltrials.gov/ct2/how/NCT02398812 .

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“…Medication use and patients' diagnoses were veri ed according to a structured protocol [11,12]. Comorbidity was de ned according to a modi ed Charlson Comorbidity Index (CCI) [13].…”

Section: Data Collectionmentioning

confidence: 99%

“…A total of 512 patients were recruited (Figure 1). The characteristics of the participants have been described previously [11].…”

mentioning

confidence: 99%

Interprofessional medication assessment among home care patients: Any impact on functioning? Results from a randomised controlled trial

Auvinen¹,

Voutilainen

Jyrkkä

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background Multimorbidity and polypharmacy are related to the use of potentially inappropriate medicines and negative clinical outcomes including drug-related adverse events and functional declines. Home care clients are a vulnerable patient group often exposed to these risks. The aim of this study was to examine whether an interprofessional medication assessment can influence the functioning of home care patients.Methods The FIMA study was a randomised controlled intervention study comparing a general practitioner-led interprofessional medication assessment conducted at the baseline of the study with usual care with a six-month follow-up. We used linear mixed models (LMM) with a random subject effect to detect differences between the usual care and intervention groups in the following outcome measures; Katz index of Activities of Daily Living (ADL), Lawton and Brody scale of Instrumental Activities of Daily Living, Timed up and go-test (TUG), Mini-Mental State Examination, Geriatric Depression Scale and the 3-level version of EQ-5D. Results Home care patients (n= 512) had major disease burdens and functional limitations. Regarding TUG times, the LMM detected a one second improvement in the FIMA group and 2.4 seconds worsening in the usual care group. However, the result was not statistically significant. The ADL revealed an interaction across time, treatment and sex (p=0.026). The ADL score decreased in both groups; the decline being the steepest among women in the intervention group. Conclusions In general, medication assessments may have limited impact on functioning of older people. Nonetheless, the FIMA intervention may prevent worsening of mobility among older home care patients. Trial registration The Interprofessional Medication Assessment for Older Patients, Clinical Trials.gov. NCT02398812. First registration, 26 March 2015. Retrospectively registered. https://www.clinicaltrials.gov/ct2/show/NCT02398812

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The Finnish Interprofessional Medication Assessment (FIMA): baseline findings from home care setting

Cited by 14 publications

References 41 publications

Clinically relevant drug‐drug interactions and the risk for drug adverse effects among home‐dwelling older persons with and without type 2 diabetes

Clinically relevant drug‐drug interactions and the risk for drug adverse effects among home‐dwelling older persons with and without type 2 diabetes

Interprofessional medication assessment among home care patients: Any impact on functioning? Results from a randomised controlled trial

Interprofessional medication assessment among home care patients: Any impact on functioning? Results from a randomised controlled trial

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