Drug Therapy, CombinationNCT02545257
Development of a Coordinated, Community-Based Medication Management Model for Home-Dwelling Aged in Primary Care
A study testing Coordinated medication management model in people with Drug Therapy, Combination and Inappropriate Prescribing, run by University of Helsinki at 2 sites in Finland.
Trial summary
The objective of this randomized controlled trial is to develop a coordinated, multiprofessional medication management model for home-dwelling aged in primary care and to study the effectiveness of this model. Read more about this study
- Who is it for?
- Ages 65 years and older
- Conditions the study is for
- Drug Therapy, Combination, Inappropriate Prescribing, Polypharmacy
- What is being tested?
- Coordinated medication management model
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 191 participants
- Where
- 2 sitesFinland
- Study dates
- Sep 2015to Dec 2018
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 65 years and older
- All sexes
- No healthy volunteers
- Older adult
Who may be able to join
- Home-dwelling over 65 year-old persons receiving regular home care from the City of Lohja
Who cannot join
- Home care is not given regularly
Trial locations and contacts
2 sites in 1 country.
Finland2 sites
1st Pharmacy of Lohja
Lohja, 08100
Services for aged people
Lohja, 08100
About this study
The objective of this randomized controlled trial is to develop a coordinated, multiprofessional medication management model for home-dwelling aged in primary care and to study the effectiveness of this model. The main hypothesis is that the new model helps to identify aged people having potential risks with their medications and thus allows solving these risks.
Read the detailed description
The demand for long-term home health care services is increasing due the demographic and societal developments. Aged people needing home care are increasingly older, have many chronic diseases and use multiple medicines and thus, are at high risk for drug-related problems (DRPs). In Finland, national and local healthcare and aged care strategies target to allowing aged people (over 65 years) living in their own homes as long as possible. This minimizes the costs of institutionalized care and also targets to add the quality of life of aged people. New approaches and service models are needed to meet these challenges.
The present study focuses on the development of a coordinated medication management model which aims to ensure the safe medication practises for home-dwelling aged in primary care. In the previous parts of this study project were developed a model for comprehensive medication review process (CMR) and a Drug-Related Problem Risk Assessment Tool. The present study uses a multistage intervention in which medications are reviewed (prescription review) in a community pharmacy using the SFINX-database to identify clinically significant drug-drug interactions and the Salko-database which identifies potentially inappropriate medications for aged people. In the next stage practical nurses use the Drug-Related Problem Risk Assessment Tool to identify potential risks. The following stages are based on the results from the risk assessment tool. Potential options are, e.g.,physician consultation, more frequent home care visits, counselling given by the community pharmacy or comprehensive medication review (CMR). The CMR process is only targeted to a limited group of study participants with clinically significant DRP who probably will benefit from more comprehensive CMR.
- Being tested
- Coordinated medication management model
- Keywords
- Aged people, Home care, Drug related problems, DRPs, Coordinated medication management model
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Coordinated medication management modelOther
Stage I: a prescription review conducted by community pharmacists Stage II: practical nurse-administered Drug-related Problem Risk Assessment Tool Stage III: Required health care action based on the result of the DRP -Risk Assessment Tool
| Study group | Role | What they receive |
|---|---|---|
| Active comparator | Active comparator | In addition to normal, standard care, participants allocated to intervention group will receive a coordinated medication management model containing prescription review, drug-related problems (DRP) risk assessment and required action based on the DRP risk assessment. Receives: Other: Coordinated medication management model |
| Control group (standard care) | No intervention | Normal, standard care (control group) |
What is being measured
The primary outcome is the main question the study is designed to answer.
GDS-15 (Geriatric Depression Scale)
Measured: Change from baseline at 12 and 24 months
MMSE (Mini-Mental State Examination)
Cognitive ability
Measured: Change from baseline at 12 and 24 months
MNA (Malnutrition Assessment)
Measured: Change from baseline at 12 and 24 months
Time to rise from a chair and return to the seated position 5 times (Lower extremity function).
Measured: Change from baseline at 12 and 24 months
Orthostatic hypotension (Short test, Freeman et al. 2011)
Measured: Change from baseline at 12 and 24 months
AUDIT-C (Alcohol Use Disorder Identification Test, version C)
Measured: Change from baseline at 12 and 24 months
UDI-6 (Urinary Distress Inventory)
Measured: Change from baseline at 12 and 24 months
Rava (Functioning and disability, Finnish Consulting Group)
Measured: Change from baseline at 12 and 24 months
Potentially inappropriate medicines (PIM) (Clinically significant drug-drug interactions, potentially inappropriate medicines for aged), identified from medication list review chart
PIMs are identified with prescription review using SFINX database (clinically significant drug-drug interactions) and Salko database (e.g., for identifying potentially inappropriate medicines for the aged, anticholinergic and serotonergic load).
Measured: Change from baseline at 12 and 24 months
Secondary outcomes (3)
Use of health care services: visits to physician
Number of visits (previous 3 months)
Measured: at 12 and 24 months from baseline
Use of health care services: hospital days
Number of hospital days (previous 3 months)
Measured: at 12 and 24 months from baseline
Use of health care services: home care services
Services delivered to home (previous 3 months)
Measured: at 12 and 24 months from baseline
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted9 Sep 2015 (estimated)
- Study startSep 2015
- Primary completionDec 2017
- Study completionDec 2018
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (16)Papers the sponsor has linked to this study.
- Other trials for Drug Therapy, CombinationStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 191 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Helsinki
- Sponsor type
- University, hospital or other
- Collaborators
- City of Lohja, Services for Aged People, Lohjan 1. Apteekki, Social Insurance Institution, Finland
- Responsible party
- Principal investigator, Terhi Toivo, University of Helsinki
- Investigators
- Marja SA Airaksinen, Professor, Study chair, University of HelsinkiJuha T Puustinen, Docent, Study director, University of Helsinki
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02545257
- Sponsor's protocol ID
- 153/13/03/00/2015
- Status last verified
- Mar 2019
- First submitted
- 4 Sep 2015
- Last updated
- 12 Mar 2019
- Results posted
- No
- Data monitoring committee
- No
Publications
Dimitrow MS, Leikola SN, Kivela SL, Passi S, Lukkari P, Airaksinen MS. Feasibility of a practical nurse administered risk assessment tool for drug-related problems in home care. Scand J Public Health. 2015 Nov;43(7):761-9. doi: 10.1177/1403494815591719. Epub 2015 Jul 7.
PubMed 26152737Dimitrow MS, Mykkanen SI, Leikola SN, Kivela SL, Lyles A, Airaksinen MS. Content validation of a tool for assessing risks for drug-related problems to be used by practical nurses caring for home-dwelling clients aged >/=65 years: a Delphi survey. Eur J Clin Pharmacol. 2014 Aug;70(8):991-1002. doi: 10.1007/s00228-014-1699-5. Epub 2014 Jun 1.
PubMed 24879605Dimitrow MS, Airaksinen MS, Kivela SL, Lyles A, Leikola SN. Comparison of prescribing criteria to evaluate the appropriateness of drug treatment in individuals aged 65 and older: a systematic review. J Am Geriatr Soc. 2011 Aug;59(8):1521-30. doi: 10.1111/j.1532-5415.2011.03497.x. Epub 2011 Jul 28.
PubMed 21797829Bulajeva A, Labberton L, Leikola S, Pohjanoksa-Mantyla M, Geurts MM, de Gier JJ, Airaksinen M. Medication review practices in European countries. Res Social Adm Pharm. 2014 Sep-Oct;10(5):731-40. doi: 10.1016/j.sapharm.2014.02.005. Epub 2014 Feb 24.
PubMed 24661800Leikola S, Tuomainen L, Peura S, Laurikainen A, Lyles A, Savela E, Airaksinen M. Comprehensive medication review: development of a collaborative procedure. Int J Clin Pharm. 2012 Aug;34(4):510-4. doi: 10.1007/s11096-012-9662-y. Epub 2012 Jun 19.
PubMed 22711383Leikola S, Dimitrow M, Lyles A, Pitkala K, Airaksinen M. Potentially inappropriate medication use among Finnish non-institutionalized people aged >/=65 years: a register-based, cross-sectional, national study. Drugs Aging. 2011 Mar 1;28(3):227-36. doi: 10.2165/11586890-000000000-00000.
PubMed 21329402Leikola SN, Tuomainen L, Ovaskainen H, Peura S, Sevon-Vilkman N, Tanskanen P, Airaksinen MS. Continuing education course to attain collaborative comprehensive medication review competencies. Am J Pharm Educ. 2009 Oct 1;73(6):108. doi: 10.5688/aj7306108.
PubMed 19885077Leikola SN, Virolainen J, Tuomainen L, Tuominen RK, Airaksinen MS. Comprehensive medication reviews for elderly patients: findings and recommendations to physicians. J Am Pharm Assoc (2003). 2012 Sep-Oct;52(5):630-3. doi: 10.1331/JAPhA.2012.10163.
PubMed 23023843Dimitrow M, Leikola S, Kivela SL, Airaksinen M, Mykkanen S, Puustinen J. [Inappropriate medication use among the aged. Review of the criteria]. Duodecim. 2013;129(11):1159-66. Finnish.
PubMed 23819202Puustinen J, Lahteenmaki R, Polo-Kantola P, Salo P, Vahlberg T, Lyles A, Neuvonen PJ, Partinen M, Raiha I, Kivela SL. Effect of withdrawal from long-term use of temazepam, zopiclone or zolpidem as hypnotic agents on cognition in older adults. Eur J Clin Pharmacol. 2014 Mar;70(3):319-29. doi: 10.1007/s00228-013-1613-6. Epub 2013 Dec 12.
PubMed 24337417Puustinen J, Nurminen J, Vahlberg T, Lyles A, Isoaho R, Raiha I, Kivela SL. CNS medications as predictors of precipitous cognitive decline in the cognitively disabled aged: a longitudinal population-based study. Dement Geriatr Cogn Dis Extra. 2012 Jan;2(1):57-68. doi: 10.1159/000336710. Epub 2012 Mar 16.
PubMed 22619661Puustinen J, Nurminen J, Lopponen M, Vahlberg T, Isoaho R, Raiha I, Kivela SL. Use of CNS medications and cognitive decline in the aged: a longitudinal population-based study. BMC Geriatr. 2011 Nov 1;11:70. doi: 10.1186/1471-2318-11-70.
PubMed 22044595Nurminen J, Puustinen J, Piirtola M, Vahlberg T, Lyles A, Kivela SL. Opioids, antiepileptic and anticholinergic drugs and the risk of fractures in patients 65 years of age and older: a prospective population-based study. Age Ageing. 2013 May;42(3):318-24. doi: 10.1093/ageing/afs178. Epub 2012 Nov 29.
PubMed 23204431Puustinen J, Nurminen J, Kukola M, Vahlberg T, Laine K, Kivela SL. Associations between use of benzodiazepines or related drugs and health, physical abilities and cognitive function: a non-randomised clinical study in the elderly. Drugs Aging. 2007;24(12):1045-59. doi: 10.2165/00002512-200724120-00007.
PubMed 18020536Toivo T, Dimitrow M, Puustinen J, Savela E, Pelkonen K, Kiuru V, Suominen T, Kinnunen S, Uunimaki M, Kivela SL, Leikola S, Airaksinen M. Coordinating resources for prospective medication risk management of older home care clients in primary care: procedure development and RCT study design for demonstrating its effectiveness. BMC Geriatr. 2018 Mar 16;18(1):74. doi: 10.1186/s12877-018-0737-z.
PubMed 29548304
Study at a glance
From the registry record, last updated by the sponsor on 12 Mar 2019. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Development of a Coordinated, Community-Based Medication Management Model for Home-Dwelling Aged in Primary Care
- ClinicalTrials.gov ID
- NCT02545257
- Acronym / sponsor ID
- 153/13/03/00/2015
- Keywords
- Aged people, Home care, Drug related problems, DRPs, Coordinated medication management model
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 191 participants (actual)
- Lead sponsor
- University of HelsinkiUniversity, hospital or other
- Collaborators
- City of Lohja, Services for Aged People, Lohjan 1. Apteekki, Social Insurance Institution, Finland
- Study start
- Sep 2015 (actual)
- Primary completion
- Dec 2017 (actual)
- Study completion
- Dec 2018 (actual)
- First posted
- 9 Sep 2015 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The objective of this randomized controlled trial is to develop a coordinated, multiprofessional medication management model for home-dwelling aged in primary care and to study the effectiveness of this model. The main hypothesis is that the new model helps to identify aged people having potential risks with their medications and thus allows solving these risks.
Detailed description
The demand for long-term home health care services is increasing due the demographic and societal developments. Aged people needing home care are increasingly older, have many chronic diseases and use multiple medicines and thus, are at high risk for drug-related problems (DRPs). In Finland, national and local healthcare and aged care strategies target to allowing aged people (over 65 years) living in their own homes as long as possible. This minimizes the costs of institutionalized care and also targets to add the quality of life of aged people. New approaches and service models are needed to meet these challenges.
The present study focuses on the development of a coordinated medication management model which aims to ensure the safe medication practises for home-dwelling aged in primary care. In the previous parts of this study project were developed a model for comprehensive medication review process (CMR) and a Drug-Related Problem Risk Assessment Tool. The present study uses a multistage intervention in which medications are reviewed (prescription review) in a community pharmacy using the SFINX-database to identify clinically significant drug-drug interactions and the Salko-database which identifies potentially inappropriate medications for aged people. In the next stage practical nurses use the Drug-Related Problem Risk Assessment Tool to identify potential risks. The following stages are based on the results from the risk assessment tool. Potential options are, e.g.,physician consultation, more frequent home care visits, counselling given by the community pharmacy or comprehensive medication review (CMR). The CMR process is only targeted to a limited group of study participants with clinically significant DRP who probably will benefit from more comprehensive CMR.
Study design
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Active comparator | Active comparator | Other: Coordinated medication management modelIn addition to normal, standard care, participants allocated to intervention group will receive a coordinated medication management model containing prescription review, drug-related problems (DRP) risk assessment and required action based on the DRP risk assessment. |
| Control group (standard care) | No intervention | –Normal, standard care (control group) |
Who may qualify
- Ages
- 65 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Older adult
Key inclusion criteria (1 listed)
- Home-dwelling over 65 year-old persons receiving regular home care from the City of Lohja
Key exclusion criteria (1 listed)
- Home care is not given regularly
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Coordinated medication management modelStage I: a prescription review conducted by community pharmacists Stage II: practical nurse-administered Drug-related Problem Risk Assessment Tool Stage III: Required health care action based on the result of the DRP -Risk Assessment Tool | Other | Active comparator |
Primary outcome
GDS-15 (Geriatric Depression Scale)
Time frame: Change from baseline at 12 and 24 months
MMSE (Mini-Mental State Examination)
Time frame: Change from baseline at 12 and 24 months
Cognitive ability
MNA (Malnutrition Assessment)
Time frame: Change from baseline at 12 and 24 months
Time to rise from a chair and return to the seated position 5 times (Lower extremity function).
Time frame: Change from baseline at 12 and 24 months
Orthostatic hypotension (Short test, Freeman et al. 2011)
Time frame: Change from baseline at 12 and 24 months
AUDIT-C (Alcohol Use Disorder Identification Test, version C)
Time frame: Change from baseline at 12 and 24 months
UDI-6 (Urinary Distress Inventory)
Time frame: Change from baseline at 12 and 24 months
Rava (Functioning and disability, Finnish Consulting Group)
Time frame: Change from baseline at 12 and 24 months
Potentially inappropriate medicines (PIM) (Clinically significant drug-drug interactions, potentially inappropriate medicines for aged), identified from medication list review chart
Time frame: Change from baseline at 12 and 24 months
PIMs are identified with prescription review using SFINX database (clinically significant drug-drug interactions) and Salko database (e.g., for identifying potentially inappropriate medicines for the aged, anticholinergic and serotonergic load).
3 secondary outcomes
Use of health care services: visits to physician
Time frame: at 12 and 24 months from baseline
Use of health care services: hospital days
Time frame: at 12 and 24 months from baseline
Use of health care services: home care services
Time frame: at 12 and 24 months from baseline
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 12 Mar 2019.
- Results publication: PubMed 26152737Dimitrow MS, Leikola SN, Kivela SL, Passi S, Lukkari P, Airaksinen MS. Feasibility of a practical nurse administered risk assessment tool for drug-related problems in home care. Scand J Public Health. 2015 Nov;43(7):761-9. doi: 10.1177/1403494815591719. Epub 2015 Jul 7.
- Results publication: PubMed 24879605Dimitrow MS, Mykkanen SI, Leikola SN, Kivela SL, Lyles A, Airaksinen MS. Content validation of a tool for assessing risks for drug-related problems to be used by practical nurses caring for home-dwelling clients aged >/=65 years: a Delphi survey. Eur J Clin Pharmacol. 2014 Aug;70(8):991-1002. doi: 10.1007/s00228-014-1699-5. Epub 2014 Jun 1.
- Results publication: PubMed 21797829Dimitrow MS, Airaksinen MS, Kivela SL, Lyles A, Leikola SN. Comparison of prescribing criteria to evaluate the appropriateness of drug treatment in individuals aged 65 and older: a systematic review. J Am Geriatr Soc. 2011 Aug;59(8):1521-30. doi: 10.1111/j.1532-5415.2011.03497.x. Epub 2011 Jul 28.
- Results publication: PubMed 24661800Bulajeva A, Labberton L, Leikola S, Pohjanoksa-Mantyla M, Geurts MM, de Gier JJ, Airaksinen M. Medication review practices in European countries. Res Social Adm Pharm. 2014 Sep-Oct;10(5):731-40. doi: 10.1016/j.sapharm.2014.02.005. Epub 2014 Feb 24.
- Results publication: PubMed 22711383Leikola S, Tuomainen L, Peura S, Laurikainen A, Lyles A, Savela E, Airaksinen M. Comprehensive medication review: development of a collaborative procedure. Int J Clin Pharm. 2012 Aug;34(4):510-4. doi: 10.1007/s11096-012-9662-y. Epub 2012 Jun 19.
- Results publication: PubMed 21329402Leikola S, Dimitrow M, Lyles A, Pitkala K, Airaksinen M. Potentially inappropriate medication use among Finnish non-institutionalized people aged >/=65 years: a register-based, cross-sectional, national study. Drugs Aging. 2011 Mar 1;28(3):227-36. doi: 10.2165/11586890-000000000-00000.
- Results publication: PubMed 19885077Leikola SN, Tuomainen L, Ovaskainen H, Peura S, Sevon-Vilkman N, Tanskanen P, Airaksinen MS. Continuing education course to attain collaborative comprehensive medication review competencies. Am J Pharm Educ. 2009 Oct 1;73(6):108. doi: 10.5688/aj7306108.
- Results publication: PubMed 23023843Leikola SN, Virolainen J, Tuomainen L, Tuominen RK, Airaksinen MS. Comprehensive medication reviews for elderly patients: findings and recommendations to physicians. J Am Pharm Assoc (2003). 2012 Sep-Oct;52(5):630-3. doi: 10.1331/JAPhA.2012.10163.
- Results publication: PubMed 23819202Dimitrow M, Leikola S, Kivela SL, Airaksinen M, Mykkanen S, Puustinen J. [Inappropriate medication use among the aged. Review of the criteria]. Duodecim. 2013;129(11):1159-66. Finnish.
- Results publication: PubMed 24337417Puustinen J, Lahteenmaki R, Polo-Kantola P, Salo P, Vahlberg T, Lyles A, Neuvonen PJ, Partinen M, Raiha I, Kivela SL. Effect of withdrawal from long-term use of temazepam, zopiclone or zolpidem as hypnotic agents on cognition in older adults. Eur J Clin Pharmacol. 2014 Mar;70(3):319-29. doi: 10.1007/s00228-013-1613-6. Epub 2013 Dec 12.
- Results publication: PubMed 22619661Puustinen J, Nurminen J, Vahlberg T, Lyles A, Isoaho R, Raiha I, Kivela SL. CNS medications as predictors of precipitous cognitive decline in the cognitively disabled aged: a longitudinal population-based study. Dement Geriatr Cogn Dis Extra. 2012 Jan;2(1):57-68. doi: 10.1159/000336710. Epub 2012 Mar 16.
- Results publication: PubMed 22044595Puustinen J, Nurminen J, Lopponen M, Vahlberg T, Isoaho R, Raiha I, Kivela SL. Use of CNS medications and cognitive decline in the aged: a longitudinal population-based study. BMC Geriatr. 2011 Nov 1;11:70. doi: 10.1186/1471-2318-11-70.
- Leikola S. Development and Application of Comprehensive Medication Review Procedure to Community-Dwelling Elderly. Doctoral Thesis, University of Helsinki, 2012Link provided by the sponsor.
- Puustinen J. Benzodiazepines and Cognitive Functioning in Older Adults. With Emphasis on Long-Term Use and Withdrawal. Doctoral Thesis, University of Turku, 2014Link provided by the sponsor.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Marja SA Airaksinen, Professor study chair
University of Helsinki
Juha T Puustinen, Docent study director
University of Helsinki
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Coordinated medication management model in people with Drug Therapy, Combination and Inappropriate Prescribing, run by University of Helsinki at 2 sites in Finland.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 12 Mar 2019. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites in Finland. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
GDS-15 (Geriatric Depression Scale) (time frame: Change from baseline at 12 and 24 months). The study lists 9 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT02545257, which also lists 16 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Mar 2019.