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Table 1 Agreed tasks of each healthcare professional and tools used in the coordinated medication management model (CoMM)

From: Coordinating resources for prospective medication risk management of older home care clients in primary care: procedure development and RCT study design for demonstrating its effectiveness

Healthcare professionals Tasks in the coordinated medication management model Tools used
Home care nurses (practical nurses, nurses) Medication reconciliation
Medication risk assessments
Clinical tests to assess clients’ functioning and disability (at baseline, 12 and 24 month follow-up)
Medication lists, usual home visits
Clinical interviews with the DRP-RAT
a) Measures used in usual clinical practice: functional ability (RAVA) [37], physical performance (The five-times-sit-to-stand test) [38, 39], cognitive functioning (MMSE) [40], depression (GDS-15) [41] and malnutrition (MNA) [42].
b) Added measures: difficulties related to urination (UDI-6) [43], orthostatic hypotension (3 min test) [44] and alcohol use (AUDIT-C) [45].
Implementing medication changes and monitoring their outcomes Regular home visits as usual
Informing physicians when needed
Community pharmacists Prescription review (PR) Clinically significant drug-drug interactions (DDIs) (SFINX) [32]
Potentially inappropriate medicines (PIMs) according to Beers 2015 criteria [46], anticholinergic and serotonergic loads of medicines (Salko) [33].
Medication review (MR) Patient information: medication list, DRP-RAT and glomerulus filtration rate (GFR) results
Other tools used: SFINX (DDIs), Pharao (Cumulative scoring of the anticholinergicity, bleeding risk, constipation, orthostatic hypotension, prolongation of QT interval, nephrotoxicity, sedation, convulsion risk and serotonergicity of the patient’s medication) [47], Salko (PIMs) [33], Renbase (Renal function and appropriateness of doses/medicines used) [9].
Comprehensive medication review (CMR) conducted by a qualified pharmacist (TT, SL) Patient information: medication list, DRP-RAT and GFR results, diagnosis, laboratory test results.
Tools used: As in MR, complemented by client’s clinical interview [20, 48]
Coordinating pharmacist Trainings of the PNs for the recruitment process, CoMM and use of DRP-RAT (MD) Meetings, discussions, personal guidance, DRP-RAT training [29]
Coordinating and organizing processes for CoMM Constructing the CoMM structure through observations, meetings, contacts and negotiations with organizations, health care professionals, researchers and home care clients involved, organizing processes and interactive training, providing training, guidance and feedback, reflecting the literature and guidelines on geriatric care and pharmacotherapy
Preparing triage meetings with the leading home care physician to decide on actions for clients with clinically significant DRPs Prescription review findings (from SFINX and Salko databases) and DRP-RAT results.
Leading home care physician Triage meetings with the coordinating pharmacist to decide on actions for clients with clinically significant DRPs (50–70 cases per triage meeting of 2 h) Prescription review findings (from SFINX and Salko databases) and DRP-RAT results.
Client’s personal physician Case-conferences with pharmacists concerning clients with clinically significant DRPs identified in MR and CMR.
Decisions on the medication changes and how they will be implemented.
Medication lists accomplished with the SFINX and Salko data, DRP-RAT results, results from the clinical tests, laboratory test (GFR), MR and CMR report, including client’s clinical interview.
  1. Abbreviations: DRP-RAT Drug-Related Problem Risk Assessment Tool [31], MMSE Mini Mental State Examination [40], GDS-15 Geriatric Depression Scale [41], MNA The Mini Nutritional Assessment [42], UDI-6 Urinary Distress Inventory [43], AUDIT-C Alcohol Use Disorder Identification Test, version C [45], SFINX Drug-drug interaction database’s new name since March 2017 is INXBASE, Pharao adverse effects database’s new name since March 2017 is RISKBASE