title: Medication review of community-dwelling seniors using intensified home-care service.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Pharmazentrum Frankfurt/ZAFES, Institute of Clinical Pharmacology at the Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Ermer
authors.forename: S
authors.initials: S
authors.lastname: Harder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods; D001569:Benzodiazepines / Q000008:administration & dosage; D015331:Cohort Studies; D003404:Creatinine / Q000032:analysis; D004305:Dose-Response Relationship, Drug; D004363:Drug Utilization; D005260:Female; D005858:Germany; D005919:Glomerular Filtration Rate; D006699:Home Care Services; D006801:Humans; D008297:Male; D059065:Medication Reconciliation; D008875:Middle Aged; D004364:Pharmaceutical Preparations / Q000008:administration & dosage* / Q000592:standards; D019338:Polypharmacy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
chemical_list: D004364:Pharmaceutical Preparations; D001569:Benzodiazepines; D003404:Creatinine