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Medication review of community-dwelling seniors using intensified home-care service

M. Ermer and S. Harder

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Volume 49 p. 179 - 184

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 49 – No. 3/2011 (179-184)

Medication review of community-dwelling seniors using intensified home-care service

M. Ermer and S. Harder

Pharmazentrum Frankfurt/ZAFES, Institute of Clinical Pharmacology at the Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
Investigations on medication burden, falling, and inappropriate dosing in renal impairment have been obtained in patients living in nursing homes. Data from home-dwelling patients in intensified ambulatory care, especially from Germany are scant. Material and method: We evaluated patients daily visited by an ambulatory care service (Cohort 1, n = 102, median age 80 y) or had care given by relatives only (cohort 2, n = 101, median age 76 y) at baseline (V1), 6 (V2) and 12 months (V3). Results: At V1 patients in Cohort 1 had 5 (median, range 3 – 15) and at V3 6 (3 – 17) medications. No differences could be observed between cohorts regarding number and pattern of medications. At V1, 30/102 patients of Cohort 1 had creatinine measured within the last 6 months, 13/30 patients had an eGFR < 50 ml/min. 6/34 medications which need dose-adjustment were unadjusted. Low surveillance of renal function and unadjusted dosing were also observed at other visits and also in Cohort 2. Within 1 year, 29/75 mobile patients in cohort 1 had a fall, 18/29 patients had a benzodiazepine prescribed regularly, whereas a benzodiazepine was prescribed in 6/46 patients which did not fall (chi² p = 0.004). In Cohort 2, the number of falling patients was lower (19/84 mobile patients, p = 0.028). 11/19 patients had a benzodiazepine prescribed, in contrast to 5/65 patients which did not fall (chi² p = 0.001). Conclusions: It needs to be elucidated whether a care service can contribute to medication safety in patients e.g. by reviewing medication charts and organizing for controls of ancillary laboratory values.Correspondence to:
Prof. Dr. med. S. Harder
Institute for Clinical Pharmacology at the Pharmazentrum Frankfurt
University Hospital Frankfurt/Main
Theodor Stern Kai 7
60590 Frankfurt am Main, Germany
Email: [email protected]

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