LNSLNS

We would like to thank Prof. Wehling for his comments on our article (1). As stated in our paper, the literature search for our review was last updated on 6 November 2015. Unfortunately, the VALFORTA study by Wehling et al. had not yet been published at that time (2). During the process of preparing the review, no further update of the literature search was performed.

As already mentioned by Prof. Wehling, apart from its primary endpoint (the FORTA score [sum of medication errors classified as over- or undertreatment and mistreatment]), the VALFORTA study collected data on clinically relevant secondary endpoints (Activities of Daily Living [ADL], Timed Up and Go (TUG) test, Tinetti test, falls, among other). In the intervention group, a statistically significant ADL improvement and reduction in acute kidney failure rate was observed. The results of the VALFORTA study are impressive, demonstrating that pharmacotherapy can be improved by applying this concept.

Likewise impressive were the results of a recently published observational study among ambulatory older patients (median age, 73 years) which found a significant association (hazard ratio 1.378; 95% confidence interval [1.349; 1.407]) between the use of potentially inappropriate medications (PIM, as defined in the PRISCUS list) and the risk of hospitalization which was unfavorable with PIM compared to alternative medications. Polypharmacotherapy was significantly more frequently (OR 1.50; [1.47–1.52]) observed in the PIM group compared to the control group (3). Since in Germany general practitioners prescribe almost 90% of the daily doses to patients aged 65 years and older (1), it is important to continue pursuing such approaches in ambulatory care.

DOI: 10.3238/arztebl.2017.0194b

On behalf of the authors:

Dr. med. Hannah Haumann

Institut für Allgemeinmedizin und Interprofessionelle Versorgung

Universitätsklinikum Tübingen, Germany
hannah.haumann@med.uni-tuebingen.de

Conflict of interest statement

The author declares that no conflict of interest exists.

1.
Moßhammer D, Haumann H, Mörike K, Joos S: Polypharmacy—an upward trend with unpredictable effects. Dtsch Arztebl Int 2016; 113: 627–33 VOLLTEXT
2.
Wehling M, Burkhardt H, Kuhn-Thiel A, et al.: VALFORTA: a randomised trial to validate the FORTA (Fit fOR The Aged) classification. Age Ageing 2016; 45: 262–7 CrossRef MEDLINE
3.
Endres HG, Kaufmann-Kolle P, Steeb V, Bauer E, Böttner C, Thürmann P: Association between potentially inappropriate medication (PIM) use and risk of hospitalization in older adults: an observational study based on routine data comparing PIM use with use of PIM alterna-
tives. PLoS One 2016; 11: e0146811 CrossRef MEDLINE PubMed Central
1.Moßhammer D, Haumann H, Mörike K, Joos S: Polypharmacy—an upward trend with unpredictable effects. Dtsch Arztebl Int 2016; 113: 627–33 VOLLTEXT
2. Wehling M, Burkhardt H, Kuhn-Thiel A, et al.: VALFORTA: a randomised trial to validate the FORTA (Fit fOR The Aged) classification. Age Ageing 2016; 45: 262–7 CrossRef MEDLINE
3. Endres HG, Kaufmann-Kolle P, Steeb V, Bauer E, Böttner C, Thürmann P: Association between potentially inappropriate medication (PIM) use and risk of hospitalization in older adults: an observational study based on routine data comparing PIM use with use of PIM alterna-
tives. PLoS One 2016; 11: e0146811 CrossRef MEDLINE PubMed Central

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