Farhad Pazan1, Heinrich Burkhardt2, Helmut Frohnhofen3, Christel Weiss4, Christina Throm5, Alexandra Kuhn-Thiel6, Martin Wehling7. 1. Institute for Experimental and Clinical Pharmacology and Toxicology, Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. 2. IV. Medical Department, Geriatrics, University Hospital Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. 3. Faculty of Health, Department of Medicine, University Witten-Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany. 4. Department of Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, Heidelberg University, Ludolf-Krehl-Str. 13-16, 68167, Mannheim, Germany. 5. Department of Cardiology and Angiology, Agaplesion Markus Hospital, Wilhelm-Epstein-Str. 4, 60431, Frankfurt, Germany. 6. MEDIAN Klinik Sonnenwende, Sonnenwendstr. 86, 67098, Bad Dürkheim, Germany. 7. Institute for Experimental and Clinical Pharmacology and Toxicology, Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. martin.wehling@medma.uni-heidelberg.de.
Abstract
PURPOSE: Physicians often face difficulties in choosing appropriate medications for multimorbid older people. The FORTA (Fit for the Aged) classification (A: absolutely, B: beneficial, C: careful, D: don't) was proposed as a clinical tool for improving the quality of drug treatment in the aged. As an implicit tool, FORTA has been shown to aid medication optimization and improve clinical end points in the VALFORTA trial. In this prospective randomized controlled study, 207 older hospitalized patients receivedstandard geriatric treatmentand 202 patients receivedFORTA-guided treatment. METHODS: Here, changes of drug prescriptions at the anatomical-therapeutic-chemical system (ATC) level were evaluated separately for important diagnoses in descriptive analyses; over- and under-treatment rates were compared between groups. RESULTS: At the individual drug/drug class level related to all important diagnoses, the application of FORTA significantly improved under-treatments for 12 drugs/drug classes (e.g., ACE inhibitors to treat arterial hypertension) and over-treatments for 7 drugs/drug classes (e.g., proton pump inhibitors to treat gastroesophageal reflux disease). CONCLUSIONS: FORTA representing the first combined positive/negative labeling approach at the individual drug level aids the optimization of drug treatment in older people as detected for drugs/drug classes at the ATC level in important indications. FORTA is effective in addressing over- and under-treatments even if analyzed for smaller subgroups of VALFORTA.
RCT Entities:
PURPOSE: Physicians often face difficulties in choosing appropriate medications for multimorbid older people. The FORTA (Fit for the Aged) classification (A: absolutely, B: beneficial, C: careful, D: don't) was proposed as a clinical tool for improving the quality of drug treatment in the aged. As an implicit tool, FORTA has been shown to aid medication optimization and improve clinical end points in the VALFORTA trial. In this prospective randomized controlled study, 207 older hospitalized patients received standard geriatric treatment and 202 patients received FORTA-guided treatment. METHODS: Here, changes of drug prescriptions at the anatomical-therapeutic-chemical system (ATC) level were evaluated separately for important diagnoses in descriptive analyses; over- and under-treatment rates were compared between groups. RESULTS: At the individual drug/drug class level related to all important diagnoses, the application of FORTA significantly improved under-treatments for 12 drugs/drug classes (e.g., ACE inhibitors to treat arterial hypertension) and over-treatments for 7 drugs/drug classes (e.g., proton pump inhibitors to treat gastroesophageal reflux disease). CONCLUSIONS:FORTA representing the first combined positive/negative labeling approach at the individual drug level aids the optimization of drug treatment in older people as detected for drugs/drug classes at the ATC level in important indications. FORTA is effective in addressing over- and under-treatments even if analyzed for smaller subgroups of VALFORTA.
Authors: Karen Barnett; Stewart W Mercer; Michael Norbury; Graham Watt; Sally Wyke; Bruce Guthrie Journal: Lancet Date: 2012-05-10 Impact factor: 79.321
Authors: Farhad Pazan; Heinrich Burkhardt; Helmut Frohnhofen; Christel Weiss; Christina Throm; Alexandra Kuhn-Thiel; Martin Wehling Journal: Drugs Aging Date: 2019-03 Impact factor: 3.923
Authors: Audrey Rankin; Cathal A Cadogan; Susan M Patterson; Ngaire Kerse; Chris R Cardwell; Marie C Bradley; Cristin Ryan; Carmel Hughes Journal: Cochrane Database Syst Rev Date: 2018-09-03