The Interprofessional Medication Assessment for Older Patients

Study Overview
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Brief Summary
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The objective of this pragmatic multi-center randomized controlled trial is to test the effectiveness of interprofessional medication assessment in older patients needing home care due to their diseases or decreased functional capacity in primary care. The main hypothesis is that intervention has a positive impact on functional capacity and for rational and safe use of medicines.

Detailed Description
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Aging increases the risk of adverse effects and interactions caused by medication. Medication reconciliation and medication review are well-known practices to optimize medicines use. Both interventions usually require a team-based approach to be effective. Medication reconciliation is the process of obtaining and documenting a complete and accurate list of current patient medications and comparing this list with medication orders at each point of care transition to identify and rectify any discrepancies before patient harm occurs. Medication review is the process of evaluating current medication treatment to manage the risk and optimize the outcomes of medication treatment by detecting, solving, and preventing medication-related problems. The present study focuses on medication assessment including both medication reconciliation and review combined to clinical assessment of an individual patient. According to a systematic review there is a need for research focusing on medication management in community settings and especially to assess the impact of medication assessment on clinical outcomes.

Official Title
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The Interprofessional Medication Assessment for Older Patients - a Multicenter Randomized Trial in Primary Care Setting

Conditions
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Multimorbidity, Polypharmacy

Intervention / Treatment
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* Other: Medication assessment and treatment plan based on it


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Home dwelling ≥65 years-old persons registered to public home care services and who have had dizziness, orthostatic hypotension or have fallen or use at least six medicines Exclusion Criteria: Home care is not responsible for patient's medication, for example due to severe chronic illness (for example severe renal insufficiency or cancer with active treatment in secondary or tertiary care).

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Active comparator<br>In addition to usual care, participants allocated to intervention group will receive medication assessment and treatment plan based on it | Other: Medication assessment and treatment plan based on it<br>* Intervention Phase I: A medication assessment conducted by an interprofessional team including nurse, pharmacist and physician. The assessment is based on current medication list and basic information cathered by nurse. Phase II: This phase is needed if the assessment cannot be conducted safely without physical examination conducted by physician. The comprehensive interprofessional assessment takes place after the clinical examination conducted by home care physician.<br>|
| No Intervention: Usual care<br>Usual care (reference group). | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Functional capacity IADL (Instrumental Activities of Daily Living) |  | at 6 months from baseline | 
| Functional capacity ADL (Activities of daily living;KATZ) |  | at 6 months from baseline | 
| Functional capacity TUG (Timed up and go) |  | at 6 months from baseline | 
| Functional capacity MMSE ( Mini-mental state examination) |  | at 6 months from baseline | 
| Functional capacity GDS (Geriatric Depression Scale)-15 |  | at 6 months from baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Use of health care services | visits to physician, hospital days and nursing care at home | at 6 and 12 months from baseline | 
| Need of services delivered to home |  | at 6 and 12 months from baseline | 
| Number of medicines |  | at 6 and 12 months from baseline | 
| Quality of medicines |  | at 6 and 12 months from baseline | 
| Cost of medicines |  | at 6 and 12 months from baseline | 
| Health related quality of life assessed with EQ-5D |  | at 6 and 12 months from baseline |