Health Data Analytics
Improved drug therapy for the elderly – The FORTA principle
In elderly patients suffering from many different chronic diseases and taking many different pharmaceuticals parallelly it can be challenging for the physicians involved in the treatment processes to find the right balance between over- and under-supply in the individual medication plans. This means one the one hand avoiding drugs which are potentially more harmful than beneficial concerning their side effects and on the other hand not forgetting those ones which are quite essential in a certain therapy, e. g. significantly reducing strokes for heart failure patients.
To support the individual treatment decisions for elderly patients Prof. Martin Wehling (University of Heidelberg) et al. developed the FORTA-classification (Fit fOR The Aged) respectively the FORTA-list which contains combinations of active agents and certain age-relevant diagnosis profiles which were rated by pharmacologists, geriatricians and other medical experts from A (positive) to D (negative). The hierarchy is A-bsolutely, B-eneficial, C-areful and D-on‘t.
In a randomised controlled trial in a clinical setting (VAL-FORTA) the application of the FORTA principle by training hospital doctors was successful in significantly reducing over- and undersupply as well as adverse drug effects in the treated population. Therefore, this clinical decision support tool shall be transformed by OptiMedis into an IT-based algorithm which can be used to similarly optimize drug therapy in ambulatory care practices or practice networks. The algorithm is already tested on different claims data set to perform epidemiologic studies (FORTA-EPI) and the retrospective results are used to validate its functionality in pilot regions from OptiMedis together with the Institute for clinical pharmacology of the University of Heidelberg. In the future a real-time application at the point of care is planned, visualizing patients’ medical histories based on the FORTA principle and providing decision support for the medical providers to optimize drug therapy. Also, benchmark comparisons between providers and patient profiling (MY-FORTA) with enhanced data inputs (e.g. vital parameters, laboratory results) are potential further functionalities, of course always being aware of all the related challenges like data protection, differences in coding quality and patient self-medication.