Multidisciplinary Program “Optimization of Drug Prescription” : Impact on the Quality of Drug Prescription in Hospitalized Elderly Patients

Overview

Drug prescription is a fundamental component of care for the elderly. Even if drugs are a chance for the older patient, because of changes in pharmacological, pharmacokinetic and pharmacodynamic parameters related with age and acute/or chronic pathologies, the risks associated with drug prescription, particularly those associated with potentially inappropriate medication (PIM), are increased in the elderly. We suppose that many of hospitalized elderly have at least one prescribed medication without valid indication. Conversely, many diseases are currently undertreated in elderly patients: e.g. medicines used to treat heart failure and osteoporosis are underused in 20 to 70% of patients. Moreover, PMI prescription is associated with an increased of morbidity, mortality, risk of drug-related adverse events, utilization of health care system, care costs and impairment of quality of life. Thus, optimization of drug prescription is a major concern for improvement of the quality and safety of care in elderly. The investigators' hypothesis is that a multidisciplinary program entitled "Optimisation de la Prescription MEDicamenteuse" ("Optimization of drug prescribing") focused on drug prescription optimization including a physician training to the specificity of the drug prescription in the elderly and a checklist allowing an adapted and standardized pharmaceutical analysis is effective in reducing PIM in elderly patients hospitalized in short-term medical and geriatric care departments.

Full Title of Study: “OPMED STUDY: Multidisciplinary Program “Optimization of Drug Prescription” : Impact on the Quality of Drug Prescription in Hospitalized Elderly Patients”

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Prospective
  • Study Primary Completion Date: June 2017

Interventions

  • Other: ” Optimisation de la Prescription MEDicamenteuse ” (“Optimization of drug prescribing”)
    • The multidisciplinary intervention program include: Awareness and training of doctors by two experts (a geriatrician and a pharmacist) within participating departments. Implementation of a checklist which aims to conduct an adapted and standardized pharmaceutical analysis

Arms, Groups and Cohorts

  • Control group
    • Patients of this group are hospitalized in a time frame where the multidisciplinary intervention program is not implemented in the medical department. Drug prescriptions are conducted under usual care in the department.
  • Intervention group
    • Patients of this group are hospitalized in a time frame where the multidisciplinary intervention program is implemented in the medical department.

Clinical Trial Outcome Measures

Primary Measures

  • Proportion of potentially inappropriate medications (PIM) prescribed in discharge of hospitalized patients from 75 years old.
    • Time Frame: at discharge (average 3 weeks)
    • Proportion of prescribed PIM will be expressed as the ratio of PIM to the total number of medication in discharge prescription sheet. PIM will be identified by 2 experts (1 doctor and 1 pharmacist) based on criteria from the lists STOPP/START and Laroche.

Secondary Measures

  • Total number of drugs prescribed per discharge prescription sheet
    • Time Frame: at discharge (average 3 weeks)
  • Number of rehospitalization within 12 months following discharge
    • Time Frame: 12 months after inclusion
  • Number of emergency admission within 12 months following hospitalization
    • Time Frame: 12 months after inclusion
  • Mortality within 12 months after hospitalization
    • Time Frame: 12 months after inclusion

Participating in This Clinical Trial

Inclusion Criteria

  • Male or female subject aged over 75 years hospitalized in one of the participating department – Patient agreed to participate Exclusion Criteria:

  • Patient with a predictive length of stay equal or less than 48 hours – Patients admitted in terminal illness

Gender Eligibility: All

Minimum Age: 75 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Hospices Civils de Lyon
  • Provider of Information About this Clinical Study
    • Sponsor

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