January 18, 2016Age and Ageing173 citationsOpen Access

VALFORTA: a randomised trial to validate the FORTA (Fit fOR The Aged) classification

MWMartin WehlingGeneral / Preventive / Lipids HBHeinrich BurkhardtHeidelberg University AKAlexandra Kuhn-ThielHeidelberg University

Structured PICO

Does the FORTA classification instruction reduce medication errors and adverse drug reactions in hospitalized geriatric patients?

Population

409 hospitalized geriatric patients (≥65 years on ≥3 drugs or ≥60 years on ≥6 drugs, with 3 relevant diseases and hospitalization for ≥5 days), mean age 81.5 years, 64% female.

Intervention

FORTA (Fit fOR The Aged) classification instruction provided to ward physicians by a FORTA team.

Comparator

Control group (no FORTA instruction provided to ward physicians).

Outcome

FORTA score (sum of medication errors classified as over-, under- and mistreatment) measured as admission/discharge differences.composite

Implementation of the FORTA classification system significantly reduced medication errors and adverse drug reactions in hospitalized older adults.

Abstract

TRIAL DESIGN: to further validate the FORTA (Fit fOR The Aged) concept, a bicentric randomised, controlled trial was run in two geriatric clinics. METHODS: patients (≥65 years, ≥3 drugs or ≥60 years, ≥6 drugs) with three relevant diseases and hospitalisation for ≥5 days were randomised. In the intervention, but not the control group, a FORTA team instructed ward physicians on FORTA. FORTA is the first positive/negative listing approach labelling medications used to treat chronic illnesses in older patients from A (indispensable), B (beneficial), C (questionable) to D (avoid). The primary end point was the FORTA score: sum of medication errors classified as over-, under- and mistreatment. Consecutive patients were randomised to the intervention and control ward; outcome assessment was blinded. RESULTS: four hundred and nine patients (age 81.5 years, 64% female, hospitalisation 17.4 days) were included. The primary end point was significantly (P < 0.0001) more reduced in the intervention versus control groups (2.7 ± 2.25 versus 1 ± 1.8, mean ± SD, intergroup comparison of admission/discharge differences). Over- and under-treatment scores and use of A (increase) and D (decrease) drugs were significantly improved (P < 0.01). The total number of adverse drug reactions (ADRs) was significantly reduced by FORTA (P < 0.05, number needed to treat is 5). Activities of daily living and renal failure improved significantly (P < 0.05). Blood pressure remained constant in the intervention, but decreased significantly in the control group. CONCLUSION: applying FORTA to hospitalised geriatric patients leads to improvement of medication quality and may improve secondary clinical end points (e.g. ADRs). The concept is amenable to successful communication and implementation. Registration (DRKS-ID): DRKS00000531. FUNDING: DFG-German Research Foundation (WE 1184/15-1).

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