The JAPAN-FORTA (Fit fOR The Aged) list: Consensus validation of a clinical tool to improve drug therapy in older adults

Farhad Pazan; Yana Gercke; Christel Weiss; Martin Wehling; FORTA Raters

doi:10.1016/j.archger.2020.104217

The JAPAN-FORTA (Fit fOR The Aged) list: Consensus validation of a clinical tool to improve drug therapy in older adults

Arch Gerontol Geriatr. 2020 Nov/Dec:91:104217. doi: 10.1016/j.archger.2020.104217. Epub 2020 Aug 3.

Authors

Farhad Pazan¹, Yana Gercke¹, Christel Weiss², Martin Wehling³; FORTA Raters

Collaborators

FORTA Raters:
Hiroshi Akazawa⁴, Taro Kojima⁵, Ryota Kumaki⁶, Masahiro Akishita⁷, Yasushi Takeya⁸, Yoshiyuki Ohno⁹, Takashi Yamanaka¹⁰, Koichi Kozaki¹¹, Yusuke Suzuki¹², Katsuyoshi Mizukami¹³, Fumihiro Mizokami¹⁴, Yoshiyuki Ikeda¹⁵, Atsuya Shimizu¹⁶

Affiliations

¹ Institute of Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Germany.
² Department of Medical Statistics, Biomathematics and Information Processing, Medical Faculty of the University of Heidelberg in Mannheim, Germany.
³ Institute of Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Germany. Electronic address: [email protected].
⁴ Department of Cardiovascular Medicine, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan.
⁵ Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁶ Division of Social Pharmacy, Department of Healthcare & Regulatory Sciences, Showa University School of Pharmacy, Tokyo, Japan.
⁷ Department of Geriatric Medicine, Graduate School of Medicine, Institute of Gerontology, The University of Tokyo, Japan.
⁸ Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
⁹ Department of Pharmacy, The University of Tokyo Hospital, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
¹⁰ Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
¹¹ Department of Geriatric Medicine, Kyorin University School of Medicine, Tokyo, Japan.
¹² Centre for Community Liaison and Patient Consultations, Nagoya University Hospital, Nagoya, Japan.
¹³ Graduate School of Comprehensive Human Sciences Faculty of Health and Sport Sciences, University of Tsukuba, Tokyo Campus, Tokyo, Japan.
¹⁴ Department of Pharmacy, National Center for Geriatrics and Gerontology, Obu, Japan.
¹⁵ Department of Cardiovascular Medicine and Hypertension, Kagoshima University, Japan.
¹⁶ Departments of Cardiology, National Center for Geriatrics and Gerontology, Obu, Japan.

PMID: 32791361
DOI: 10.1016/j.archger.2020.104217

Abstract

Purpose: Multimorbidity and subsequent polypharmacy are highly prevalent in older people. To improve inappropriate drug treatment, listing approaches such as the Beers or FORTA lists have been developed. Latter is the only clinically validated drug list issuing both positive (FORTA labels A, B) and negative (FORTA labels C, D) recommendations. Several country-specific FORTA lists have been developed to acknowledge national prescription habits, drug availabilities, and expert opinions. Here, this approach was applied to Japan.

Methods: 13 Japanese experts in geriatric pharmacotherapy participated as raters in a 2-step Delphi consensus validation of the FORTA list. The proposal of FORTA labels was based on the EURO-FORTA List and raters were asked to add, delete or re-evaluate medications, add relevant diagnoses and comments.

Results: The final JAPAN-FORTA list contains 210 items aligned to 24 main indication groups. 15 items were added to the proposal and the 71 items either not used/approved in Japan or not evaluated by any rater (oncological drugs) were removed. Excluding latter, the JAPAN-FORTA list differs from the EURO-FORTA list by 23 %. Removals mainly concerned psychotropic drugs. A maximum of one label was changed per indication. The majority (96.9 percent) of the proposed FORTA labels were confirmed, only 6 labels had to be changed.

Conclusion: The new JAPAN-FORTA list addresses the appropriateness of drug treatment in older people in Japan. This unique listing approach issuing both positive and negative medication recommendations has been shown to improve of drug therapy in older adults and its country-specific version is now available for Japan.

Keywords: Drug therapy; FORTA (Fit fOR The Aged) list; Geriatrics; Inappropriate prescribing; Older people; Potentially inappropriate medication list.