The primary objective of this study is to evaluate the impact of the implementation of collaborative pharmaceutical care on drug support at admission for patients 65 years of age and older. This is a cluster-randomized study with a stepped-wedge design. Clusters correspond to participating centers. A randomly selected center is crossed-over into the intervention every fifteen days after the start of inclusions.
The secondary objectives are to evaluate: A. The potential and observed clinical impact of the implementation of collaborative pharmaceutical care. B. The acceptance rate of pharmaceutical interventions during collaborative pharmaceutical care. C. Avoidable costs related to the consumption of care generated by the occurrence of serious adverse drug reactions. D. The satisfaction of health professionals concerning the transfer of information on the patient's drug therapy carried out as part of collaborative pharmaceutical care.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
622
The pharmacist performs collaborative pharmaceutical care in the ward: reconciliation of drug treatments and revision of drug prescriptions indicated on the admission drug prescription. He/she emits pharmaceutical interventions recorded on the standardized support provided by the French Society of Clinical Pharmacy. The pharmaceutical interventions are discussed during a collaborative interview.
CHU de Grenoble - Hôpital Albert Michallon
Grenoble, France
CHU de Nice - Hôpitaux L'Archet 1 et 2
Nice, France
CHRU de Nîmes - Hôpital Universitaire Carémeau
Nîmes, France
CHU de Rouen - Hôpital Charles Nicolle
Rouen, France
CHRU de Strasbourg - Hôpital de Hautepierre
Strasbourg, France
CHRU de Toulouse - Hôpital Paule de Viguier
Toulouse, France
Number of patients with at least one preventable medication error
Time frame: Day 1 (medical prescription at hospital admission)
Number of patients with at least one preventable medication error
Number of patients with at least one preventable medication error not accepted by the prescribing doctor during the interventional phase
Time frame: Phase 2 (maximum 105 days)
Preventable medication error rate
Potential clinical impact: preventable medication error rate detected in the medical prescription at admission (MPA) according to the level of criticality 1, 2 or 3. This error rate is defined by the ratio of the number of avoidable errors to the number of unrevised lines in the MPA.
Time frame: Day 1 (medical prescription at hospital admission)
Number of patients at high risk for adverse drug events
Potential clinical impact: number of patients at high risk for adverse drug events (Trivalle score calculated on the medical prescription at hospital admission)
Time frame: Day 1 (medical prescription at hospital admission)
Readmission rate for in-patient hospitalization
Clinical impact observed: readmission rate for in-patient hospitalization
Time frame: 30 days after hospital discharge (expected maximum of 21 days of hospitalization)
Readmission rate for in-patient hospitalization
Clinical impact observed: readmission rate for in-patient hospitalization
Time frame: 90 days after hospital discharge (expected maximum of 21 days of hospitalization)
Mortality rate
Time frame: 30 days after hospital discharge (expected maximum of 21 days of hospitalization)
Mortality rate
Time frame: 90 days after hospital discharge (expected maximum of 21 days of hospitalization)
Length of hospital stay
Time frame: hospital discharge (expected maximum of 21 days of hospitalization)
Acceptance rate of pharmaceutical interventions during collaborative interview.
Time frame: Day 1, hospital admission
Avoided costs related to the occurrence of medication errors (criticality 3)
Time frame: 90 days after hospital discharge (expected maximum of 21 days of hospitalization)
Satisfaction questionnaire (for health care professionals) on the implementation of collaborative pharmaceutical care
Time frame: End of study (expected at 195 days)
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