251 / 290
myelogram and infectious diseases investigation were negative. From
the chest/abdominal CTs the only finding was an effusion located in
the left thigh. During investigation she received 3 RBCs units. In the
absence of diagnosis we reevaluated the imaging studies during the
past three months and the femoral effusion was present with
unchanged size. Rivaroxaban discontinued for 2 days; subsequently
the patient received enoxaparin and was discharged. One month later
the Hct remained stable and the femoral effusion was absent.
Conclusion:
Chronic blood loss due to hematoma must be considered
in the differential diagnosis of anemia especially in patients that
underwent invasive procedures and consecutively continue to receive
anticoagulants.
P-818
The effectiveness of geriatric integrated outpatient service in a
tertiary teaching hospital in southern Taiwan
Y.-C. Wang.
Center for Geriatrics and Gerontology, Kaohsiung Veterans
General Hospital
Introduction:
To evaluate the effectiveness of geriatric integrated
outpatient service in a tertiary teaching hospital.
Methods:
This prospective study enrolled the subjects aged 65 years
and over who visited the geriatric outpatient service for study. Those
who visited our hospital for 4 times andmore in the past one year were
recruited and those who didn
’
t visit our hospital 9 months later were
excluded. The clinical pharmacists would interview every patient and
reported the results to geriatricians. The number of drugs, the visiting
times and the expenditure of drugs one year before and after the first
visit to the geriatric integrated clinics were recorded from the
computer system of our hospital for comparison.
Results:
From Jan 2008 to Dec 2012, 999 older people were enrolled
(mean age = 83.3, SD = 6.93, 69.5% male). By comparing previous one
year to intervention year, the total visiting times for all outpatient
services decreased for 21.3% (from 12.7 to 10.0 times per person), total
cost of drugs decreased for 12.3% (from 412 to 357 in Euros per person)
and total numbers of drug per person per year decreased for 15.5%
(average 5.6
–
4.7 tablets per person).
Conclusions:
Through geriatric integrated outpatient service with
cooperation with clinical pharmacists, the number of drugs, the times
of visiting for outpatient services and the expenditure of drugs could
decrease significantly. Further outcome study is needed to conclude
the benefits of geriatric integrated outpatient service.
P-819
EURO-FORTA: a study to promote the usage of the FORTA (Fit fOR
The Aged) List internationally
F. Pazan, M. Wehling.
Institute for Experimental and Clinical
Pharmacology and Toxicology, Medical Faculty Mannheim, Ruprecht-
Karls-University Heidelberg
Introduction:
The elderly are the main recipients of medications in
many regions of the world. Numerous trials have revealed that a large
section of the elderly is subject to inadequate drug treatment. The
reason is that for most of the drugs there is hardly any evidence
regarding efficacy and safety in the aged. Furthermore, the presence of
multimorbidity and as a result polypharmacy aggravates this problem.
In order to effectively address this issue and to ameliorate the
appropriateness and quality of drug treatment in the elderly, our group
has developed a clinical aid called the FORTA List. FORTAwas originally
created byWehling, and the FORTA List was validated by 20 experts in a
Delphi consensus procedure. Furthermore, we evaluated FORTA
’
s
utility in a pilot clinical trial and in a randomized prospective trial.
These two studies showed that FORTA significantly (p < 0.001)
improves the quality of drug treatment.
Methods:
Based on these results, we conducted a consensus validation
of country-specific FORTA Lists in the UK, France, Poland, Italy, Spain,
the Nordic countries and the Netherlands. In this study, we used a self-
developed algorithm to choose experts in the field of geriatrics with
high experience in pharmacotherapy.
Results:
46 experts agreed to participate in our study. In a preliminary
analysis of the data from 4 participating countries each mean
consensus coefficient was higher than 0.9.
Conclusions:
The overall consensus among experts is very high. The
outcomes of this project will be used to develop country-specific
FORTA Lists and a European FORTA List.
P-820
A crucial update of the FORTA (
“
Fit fOR The Aged
”
) List: a clinical
tool for the optimization of drug treatment in the elderly
F. Pazan, M. Wehling.
Institute for Experimental and Clinical
Pharmacology and Toxicology, Medical Faculty Mannheim, Ruprecht-
Karls-University Heidelberg
Introduction:
Numerous trials have revealed that the aged are often
subjects to inappropriate and unsafe drug treatment. The main reason
for this problem is that for most of the drugs there is no evidence
regarding efficacy and safety in the aged. This problem is worsened by
the high prevalence of multimorbidity and therefore polypharmacy in
this population. To raise the appropriateness of pharmacotherapy in
the aged, we have developed a clinical aid called the FORTA List. FORTA
was originally invented by Wehling and validated and expanded by
twenty experts in a Delphi consensus procedure. Subsequently, we
evaluated FORTA
’
s usefulness in a pilot clinical trial as well as in a
controlled prospective trial. These trials showed that FORTA signifi-
cantly increases the quality of pharmacotherapy and reduces the
frequency of adverse drug reactions.
Methods:
As an evidence-based document the FORTA List needs
regular updates as the field of geriatric pharmacology progresses
rapidly. Thus, we performed a newDelphi survey to update this helpful
clinical tool. This Delphi consensus procedure involved over 20 experts
who evaluated the proposal of 4 initiators.
Results:
The new FORTA List now contains nearly 50 additional items
as compared to its first version and 3 new indications (nausea and
vomiting, hypothyroidism, obstipation) were added to the list
resulting in almost 30 indications in total. The overall mean consensus
coefficient which reflects the degree of agreement among raters
increased from 92.2% to 93.8%.
Conclusion:
All in all, the updated list now incorporates more illnesses
and contains more drugs used to treat the elderly.
P-821
Pharmaceutical care in geriatrics in Poland
A. Neumann-Podczaska, E. Grzeskowiak, K. Wieczorowska-Tobis.
Poznan University of Medical Sciences, Poznan, Poland
Introduction:
In Poland, in spite of the alarming data regarding the
potential inappropriateness of pharmacological treatment among
elderly, there is no system of pharmaceutical care. The aim of the
research was to create a practical model for pharmaceutical care in
geriatrics which will be based on the set of Criteria Defining
Potentially Inappropriate Pharmacotherapy in Geriatrics developed
within the project.
Methods:
The study was done among 300 elderly patients (195 female
[F], 105 men [M]; mean age: 74.9 ± 7.3] within 10 public pharmacies.
The including criteria was patient age (65 years+) and the number
of drugs (prescribed [Rp] and over the counter [OTC]) taken regularly
(10+) Pharmacists involved within the projects organized meetings
with the patients to assess the appropriateness of pharmacological
treatment and in case of incorrect treatment they undertook the
pharmaceutical interventions.
Results:
The mean number of Rp and OTC drugs before and after the
pharmaceutical intervention was relatively: 11.8 ± 2.9 (F:11.8 ± 2.8;
M:11.9 ± 3.3) and 11.5 ± 2.9 (F:11.5 ± 2.7; M:11.6 ± 3.3). The mean
number of consulting physicians was 3.6 ± 0.9 (87% of studied subjects
were seen by general practitioners and 73% by cardiologists). The
major inappropriateness of treatment involved: concomitant usage of
NSAIDs (ibuprofen, diclofenac, naproxen) and ACE-I (enalapril,
perindopril) in subjects with hypertension, consumption of NSAIDs
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S245