A glimpse of the future: MyForta reviews patient-specific drug provision for older patients
Dr Friederike Jensen enters the latest diagnostic findings for her 78-year-old patient Caroline Meyer into the practice computer. Unfortunately, heart failure has been added to the patient’s long-standing type 2 diabetes mellitus, obesity and high blood pressure, and she suffers from shortness of breath and swelling of the legs. Having entered these indications, Dr Jensen receives a message from her practice IT service, listing which medications the MyFORTA tool suggests for this diagnosis according to FORTA classes A (Absolutely) and B (Beneficial), and which medications are classified as FORTA classes C (Careful) and D (Don’t) and so not recommended.
Algorithms are not prescriptive – they require the doctors expert know how to take a decision about the prescription
Based on her knowledge of the patient's history and the overall composition of the patient’s pharmaceutical treatment, in this case Dr Jensen opts for one heart failure medication from class B and an additional one from class A (the patient was already taking another class A medication due to another condition). Another drug, which is actually always prescribed for younger patients, is only rated class C by FORTA, and is therefore not recommended for this patient.
How doctors feel about the use of MyForta
She explains: “In 80% of cases, I follow the recommendations of the MyForta tool. For me, this is a valuable way to ease my workload, it saves time and gives me security. Nevertheless, I am always free to my make own decision. I find it particularly helpful that MyForta also shows me the reason for the suggestion. So, at the same time I am learning indirectly from its recommendations.”
This example shows how the supply of medicine can be monitored individually in the near future, reducing the burden on doctors and supporting them in their decision-making. OptiMedis is currently working with Professor Dr Martin Wehling on such an analysis tool, and from autumn/winter 2020, a prototype of "MyFORTA" will be tested in the first regions. Interested parties are welcome to contact us. Further research projects for validation are also planned.
Prescriptions in test regions: One third too much, two thirds too little
MyFORTA is a development of the FORTA EPI algorithm that OptiMedis and Prof Wehling first introduced in 2019 for the analysis of large quantities of data from health insurance companies and research projects. Based on the FORTA (Fit fOR The Aged) classification scheme, developed in collaboration with other experts under the leadership of Prof Wehling, which hierarchically evaluates active ingredients in combination with age-relevant indications from A (positive) to D (negative), the automated algorithm can review drug provision at the regional or practice level for over- and under-provision, as well as misprovision, in multi-morbid elderly patients.
The results of the algorithmic analyses allow the provision to be adjusted accordingly. In two test regions, for example, one-third of patients received at least one less-suitable drug, and two-thirds were not given drugs that would have provided more appropriate support. OptiMedis and Prof Wehling are continuing to develop these algorithms. OptiMedis is optimising the IT tool for deployment on computers in medical practices. The algorithm for MyFORTA will now be further developed to allow it to be used for individual patients and to include information on their current health condition in the analysis.
A recent article on this topic: The Fit fOR The Aged (FORTA) project and its clinical implications