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

K Auvinen, A Voutilainen, J Jyrkkä, E Lönnroos, P Mäntyselkä, K Auvinen, A Voutilainen, J Jyrkkä, E Lönnroos, P Mäntyselkä

Abstract

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 s 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.

Keywords: Functioning; Home care; Medication therapy management; Medicines; Older people.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the study
Fig. 2
Fig. 2
Estimated marginal means of functioning outcomes from Linear Mixed Models. FIMA denotes the intervention treatment. Lowercases refer to functioning measures as follows: a Katz index of Activities of Daily Living (ADL), b the Lawton and Brody scale of Instrumental Activities of Daily Living (IADL), c the Timed Up and Go test (TUG), d the Mini-Mental State Examination (MMSE), e the Geriatric Depression Scale (GDS-15), and f) the EuroQol health-related quality of life instrument (EQ-5D-3L)

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