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Changes in prescription patterns in older hospitalized patients: the impact of FORTA on disease-related over- and under-treatments

  • Pharmacoepidemiology and Prescription
  • Published:
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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 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.

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Funding

The study was funded by the DFG-German Research Foundation (WE 1184/15-1 to M.W. and H.B., FR2997/2-1 to H.F.).

Author information

Authors and Affiliations

  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

    Farhad Pazan & Martin Wehling

  2. IV. Medical Department, Geriatrics, University Hospital Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Heinrich Burkhardt

  3. Faculty of Health, Department of Medicine, University Witten-Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany

    Helmut Frohnhofen

  4. Department of Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, Heidelberg University, Ludolf-Krehl-Str. 13-16, 68167, Mannheim, Germany

    Christel Weiss

  5. Department of Cardiology and Angiology, Agaplesion Markus Hospital, Wilhelm-Epstein-Str. 4, 60431, Frankfurt, Germany

    Christina Throm

  6. MEDIAN Klinik Sonnenwende, Sonnenwendstr. 86, 67098, Bad Dürkheim, Germany

    Alexandra Kuhn-Thiel

Authors
  1. Farhad Pazan
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  2. Heinrich Burkhardt
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  3. Helmut Frohnhofen
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  4. Christel Weiss
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  5. Christina Throm
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  6. Alexandra Kuhn-Thiel
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  7. Martin Wehling
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Corresponding author

Correspondence to Martin Wehling.

Ethics declarations

The study was approved by the ethic committees at the Medical Faculty Mannheim, Heidelberg University, and at the University of Witten-Herdecke.

Conflicts of interest

M.W. was employed by AstraZeneca R&D, Mölndal, as director of discovery medicine (=translational medicine) from 2003 to 2006, while on sabbatical leave from his professorship at the University of Heidelberg. Since returning to this position in January 2007, he has received lecturing and consulting fees from Sanofi-Aventis, Bayer, Boehringer-Ingelheim, Novartis, Takeda, Roche, Pfizer, Bristol-Myers, Daichii-Sankyo, Lilly, Otsuka, Novo-Nordisk, Shire, and LEO Pharma. H.F. received lecturing and consulting fees from Amgen. F.P., H.B., C.T., A.K.T., and C.W. declare that they have no conflicts of interest.

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Pazan, F., Burkhardt, H., Frohnhofen, H. et al. Changes in prescription patterns in older hospitalized patients: the impact of FORTA on disease-related over- and under-treatments. Eur J Clin Pharmacol 74, 339–347 (2018). https://doi.org/10.1007/s00228-017-2383-3

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  • DOI: https://doi.org/10.1007/s00228-017-2383-3

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