Aging is often associated with multiple chronic conditions conducting increased consumption of drugs. Drug therapy is necessary for the treatment of many diseases. However, misuse of drugs, particularly linked to the potentially inappropriate prescribing and polypharmacy, increases the iatrogenic risks and can lead to adverse events such as falls, cognitive decline, increased use to the health system: hospital admissions, emergency room visits, and institutionalization. These problems are common since about 20% of emergency room use in elderly patients due to an adverse event related to drugs. Nearly 28% of adverse events related to drug prescriptions could be avoided. Interventions to optimize drug therapy showed a reduction in the number of potentially inappropriate medications, but their impact on health, has rarely been evaluated. If an association with death has been established, the link with the loss of functional autonomy, which leads to reduced quality of life and significant cost of care, has not been investigated. The evolution towards functional disabilities, frequent with aging has many causes, among which some could be prevented. The optimization of drug prescriptions could thereby delay or prevent the loss of functional autonomy by reducing the risk of adverse events, such as falls or cognitive decline and improving the management of chronic diseases. Our hypothesis is that an optimization program of the drug prescribing may slow progression to functional dependence. To assess the effect of the optimization program of drug prescribing on the level of functional autonomy, a multicenter Randomized Controlled Trial will be conducted in geriatric and memory consultations. Expected results The implementation of the "OPTIM" program should enable optimization of drug prescribing in elderly patients and therefore slow or prevent progression to addiction. It should also help to develop and strengthen collaboration and communication between the team of geriatric consultation, the clinician pharmacist and referring physicians in town (private practice). In addition, pharmaceutical notice sent to referring physicians should help raise awareness of the prescription of drugs in these patients.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
302
The patients included in this group will have the intervention. The optimization of drug prescribing consists to a history of the drugs prescribing leading to pharmaceutical recommendations by the pharmacist-clinician, accepted by the specialist physicians in charge of the patient at the hospital and sent to the referring physicians of patients, who can accept or not the recommendations.
Hôpital gériatrique du Mont d'Or
Albigny-sur-Saône, France
NOT_YET_RECRUITINGHôpital des Charpennes
Lyon, France
RECRUITINGThe evolution of the level of functional autonomy of the patients assessed using the scale IADL of Lawton
The primary outcome will be calculated using the 4 successive evaluations of IADL scale. The IADL scale assesses the level of functional autonomy of a patient through the assessment of instrumental activities of daily living: ability to use the telephone, transportation, shopping, managing medications, manage a budget, prepare meals, maintain the house and do the laundry. The rating scale provides a score from 0 to 8. A higher score indicates a higher level of dependency, while a lower score reflects a lower level of dependence. The IADL scale consists of 8 questions.
Time frame: At inclusion
The evolution of the level of functional autonomy of the patients assessed using the scale IADL of Lawton
The primary outcome will be calculated using the 4 successive evaluations of IADL scale.
Time frame: At 1 month
The evolution of the level of functional autonomy of the patients assessed using the scale IADL of Lawton
The primary outcome will be calculated using the 4 successive evaluations of IADL scale.
Time frame: At 6 months
The evolution of the level of functional autonomy of the patients assessed using the scale IADL of Lawton
The primary outcome will be calculated using the 4 successive evaluations of IADL scale.
Time frame: At 18 months
The evolution of the level of functional autonomy of the patients assessed using the scale DAD-6.
The primary outcome will be calculated using the 4 successive evaluations of DAD-6 scale. The scale DAD-6 assesses the patient's activities in his daily life. It includes six questions assessing the degree of autonomy for the following activities: Food, use the telephone or the computer, moving outside, finance and correspondence, medications, leisure and home maintenance. The score ranges from 0 to 18 points, the higher the score, the more the patient is autonomous.
Time frame: At inclusion
The evolution of the level of functional autonomy of the patients assessed using the scale DAD-6.
The primary outcome will be calculated using the 4 successive evaluations of DAD-6 scale. The scale DAD-6 assesses the patient's activities in his daily life. It includes six questions assessing the degree of autonomy for the following activities: Food, use the telephone or the computer, moving outside, finance and correspondence, medications, leisure and home maintenance. The score ranges from 0 to 18 points, the higher the score, the more the patient is autonomous.
Time frame: At 1 month
The evolution of the level of functional autonomy of the patients assessed using the scale DAD-6.
The primary outcome will be calculated using the 4 successive evaluations of DAD-6 scale. The scale DAD-6 assesses the patient's activities in his daily life. It includes six questions assessing the degree of autonomy for the following activities: Food, use the telephone or the computer, moving outside, finance and correspondence, medications, leisure and home maintenance. The score ranges from 0 to 18 points, the higher the score, the more the patient is autonomous.
Time frame: At 6 months
The evolution of the level of functional autonomy of the patients assessed using the scale DAD-6.
The primary outcome will be calculated using the 4 successive evaluations of DAD-6 scale. The scale DAD-6 assesses the patient's activities in his daily life. It includes six questions assessing the degree of autonomy for the following activities: Food, use the telephone or the computer, moving outside, finance and correspondence, medications, leisure and home maintenance. The score ranges from 0 to 18 points, the higher the score, the more the patient is autonomous.
Time frame: At 18 months
Number of Hospitalizations
the occurrence of hospitalizations within 18 months after baseline
Time frame: Baseline, 1 month, 6 months and 18 months
Number of days before hospitalizations
delay between baseline and the hospitalization
Time frame: Baseline, 1 month, 6 months and 18 months
Occurrence of recourse to emergency service
occurrence of recourse to emergency service within 18 months after baseline
Time frame: Baseline, 1 month, 6 months and 18 months
Number of days before the recourse to emergency service
delay between baseline and the recourse to emergency service
Time frame: Baseline, 1 month, 6 months and 18 months
The occurrence of admission in institution
the occurrence of admission in institution within 18 months after baseline
Time frame: Baseline, 1 month, 6 months and 18 months
Number of days before admission in institution
delay between baseline and the admission in institution
Time frame: Baseline, 1 month, 6 months and 18 months
Death
the occurrence of death within 18 months after baseline
Time frame: Baseline, 1 month, 6 months and 18 months
Number of days before death
delay between baseline and death
Time frame: Baseline, 1 month, 6 months and 18 months
Falls
the occurrence of falls within 18 months after baseline
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Time frame: Baseline, 1 month, 6 months and 18 months
Number of days before falls
the delay between baseline and falls
Time frame: Baseline, 1 month, 6 months and 18 months
Cognitive functions
The cognitive function is measured by the Mini Mental State Examination (MMSE) at every visit, as part of the routine care pathway of the patient. Successive scores will be used to measure the evolution of MMSE.
Time frame: Baseline, 6 months and 18 months
Quality of life 1
Quality of life measured by questionnaire QoL-AD
Time frame: Baseline, 6 months and 18 months
Quality of life 2
Quality of life measured by questionnaire EUROQOL 5D
Time frame: Baseline, 6 months and 18 months
depression disorders
depression measured with the mini-GDS scale
Time frame: Baseline, 6 months and 18 months
Anxiety disorders
Anxiety disorders will be measured with the Hamilton scale
Time frame: Baseline, 6 months and 18 months
Compliance of patients with treatment
compliance is measured with the questionnaire Girerd
Time frame: Baseline, 6 months and 18 months
Pain
Pain is measured with an ordinal scale from 0 to 10
Time frame: Baseline, 6 months and 18 months
Proportion of potential inappropriate medication
The proportion of potential inappropriate medication will be measured on the drug prescribing of the patients issued from the referring physician
Time frame: Baseline, 1 month, 6 months and 18 months
Problems associated with drug therapy
The proportion of problems associated with drug therapy will be measured on the drugs prescribing of the patients issued from the referring physician
Time frame: Baseline, 1 month, 6 months and 18 months
acceptance rate by the referring physicians of pharmaceutical recommendation
The acceptance rate of the pharmaceutical review will be evaluated in 2 complementary ways: * By comparing patients' prescriptions issued by the referring physician before and after the pharmaceutical review. * By interviewing the referring physician
Time frame: Baseline, 1 month, 6 months and 18 months