Impact of a Mobile Geriatric Team With a Pharmacist on the Optimisation of Prescriptions in Elderly Inpatients

Overview

In patients aged 75 years and older, polypathology is frequent and often associated with polypharmacy. This polypharmacy coupled with a lack of proactive elderly care can sometimes lead to hospitalisation. Due to comorbidities and complex problems, management of geriatric patients usually requires a multidisciplinary approach. In Toulouse University Hospital, elderly inpatients can benefit from a geriatric assessment by a Geriatric Mobile Team. Whether this team improve the prescriptions through the advice of a clinical pharmacist has not been demonstrated yet.

Study Type

  • Study Type: Interventional
  • Study Design
    • Intervention Model: Single Group Assignment
    • Primary Purpose: Supportive Care
    • Masking: None (Open Label)
  • Study Primary Completion Date: January 2021

Detailed Description

All participants will be identified via the geriatrician of the mobile geriatric team with the following inclusion criteria: age ≥ 75 years, ≥ 5 medications per day and being hospitalised either in emergency room, short-stay medicine unit or in a surgery department. For each patient, the pharmacist will detect potentially inappropriate prescribing (based on explicit criteria and an implicit approach) and liaise with the geriatrician for drug optimisations. The pharmaceutical advice will be added to the geriatrician's written report, and then addressed to the relevant physician. The implementation of the proposals will be evaluated immediately at the end of hospitalisation, and then reassessed three months later by calling the patient and/or his community pharmacist. A total of 250 patients will be enrolled over a 12 month-period. The evolution of potentially inappropriate prescribing will be assessed and their cost evaluated.

Interventions

  • Other: Medication therapy management
    • The intervention is in the form of a pharmacist-led medication review aimed at detecting potentially inappropriate prescribing. It includes: Data collection on comorbidities, medication and laboratory results. A pharmacist’s evaluation of the prescriptions based on the patient’s conditions and on the current recommendations for clinical practice. A detailed feedback to the geriatrician. A written report addressed to the attending physician

Arms, Groups and Cohorts

  • Experimental: Medication therapy management
    • Medication therapy management by pharmacist-led medication review

Clinical Trial Outcome Measures

Primary Measures

  • Change from baseline patients’ number of potentially inappropriate prescription at the patient discharge after optimization by a mobile geriatric team with pharmacist
    • Time Frame: Month 0 and max Month 2 (At the patient discharge)
    • number of potentially inappropriate prescribing per patient before (month 0) and after the intervention of the mobile geriatric team (at the patient discharge)

Secondary Measures

  • Change from baseline patients’ number of potentially inappropriate prescription at 3 months after optimization by a mobile geriatric team with pharmacist
    • Time Frame: Month 0, Month 3
    • number of potentially inappropriate prescribing per patient before (month 0) and after the intervention of the mobile geriatric team (month 3)
  • Change from baseline patients’ number with at least one potentially inappropriate drug at 3 months after optimization by a mobile geriatric team with pharmacist
    • Time Frame: Month 0, Month 3
    • number of patients with at least one potentially inappropriate drug before (month 0) and after the intervention of the mobile geriatric team (month 3)
  • Change from baseline ratio of potentially inappropriate drug per patient at 3 months after optimization by a mobile geriatric team with pharmacist
    • Time Frame: Month 0, Month 3
    • ratio of potentially inappropriate drug per patient before (month 0) and after (month 3) the intervention of the mobile geriatric team.
  • Change from baseline mean number of medications per patient at 3 months
    • Time Frame: Month 0, Month 3
    • Mean number of medications per patient
  • realisation of a pharmacist-led medication review in primary care
    • Time Frame: Month 3
    • Number of pharmacist-led medication review performed in primary care at 3 months
  • number of falls 3 months after pharmacist-led medication review
    • Time Frame: Month 3
    • Number of falls
  • mortality 3 months after pharmacist-led medication review
    • Time Frame: Month 3
    • Number of deaths
  • re-hospitalisation, including emergency room transfers
    • Time Frame: Month 3
    • Number of non-scheduled hospitalisations (including emergency department transfers)
  • The nursing home transfers
    • Time Frame: Month 3
    • Number of nursing home transfers

Participating in This Clinical Trial

Inclusion Criteria

  • Patient aged 75 or older
  • Having 5 medications or more per day
  • Being hospitalised either in emergency room, short-stay medicine unit or surgery department

Exclusion Criteria

  • Patient refuses to participate
  • Patient already included in another study

Gender Eligibility: All

Minimum Age: 75 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • University Hospital, Toulouse
  • Collaborator
    • Institut National de la Santé Et de la Recherche Médicale, France
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Philippe CESTAC, PharmD, PhD, Principal Investigator, Toulouse University Hospital
  • Overall Contact(s)
    • Philippe CESTAC, PharmD, PhD, +33 5 61 77 11 59, cestac.p@chu-toulouse.fr

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