In the context of the ageing of the French population, drug iatrogeny in the elderly is a major public health issue, responsible for approximately 7,500 deaths per year and 3.4% of hospitalizations among patients aged 65 and over. The interest of the Medication Reconciliation (MR) in reducing medication errors and unintentional discrepancies in prescriptions at transition points in patients' medication care pathways no longer seems to be in doubt both in France and abroad. On the other hand, the literature on the clinical impact of these drug errors (i. e. occurrence of an adverse drug event (ADE) or readmission rates) is currently limited in France and presents variable results abroad.
The medication reconciliation implementation mobilizes human resources (pharmacists, pharmacy technician, nurses...) and constitutes an investment for healthcare institutions. However, the resulting improvement in patients' health status (and the potential reduction in ADEs) could reduce their care consumption and thus reduce costs from a healthcare system perspective. We therefore propose to assess the cost-effectiveness of this care strategy. Finally, we will study the impact of the MR deployment on existing professional organizations, both in hospital and between community healthcare professionals and hospital as well as its conditions of implementation.
Study Type
OBSERVATIONAL
Enrollment
443
During hospitalization, the hospital pharmacist will carry out a pharmaceutical analysis for all patients included in the study, each time the prescription is changed and within a maximum of 24 hours (working days). If necessary, in consultation with the doctor in charge of the patient, the pharmacist may also propose a pharmaceutical interview to the patient at any time during his hospitalisation (e.g. proposal for the de-prescription of benzodiazepines, Proton Pump Inhibitors, etc., according to the recommendations in force).
Hopital des Marches de Bretagne
Antrain, France
General Hospital
Fougères, France
General Hospital
Janzé, France
General Hospital
Montfort-sur-Meu, France
University Hospital
Rennes, France
General Hospital
Saint-Méen-le-Grand, France
Adverse drug event-related hospital revisits
Rate of adverse drug event-related hospital revisits within 30 days after discharge
Time frame: 30 days after discharge
General Practitioner consultation
Rate of General Practitioner consultation within 30 days after discharge
Time frame: 30 days after discharge
All-causes readmissions and/or Emergency Department visits
Composite rate of readmissions and/or Emergency Department visits within 30 days after discharge
Time frame: 30 days after discharge
All-causes readmissions and/or Emergency Department visits
Composite rate of readmissions and/or Emergency Department visits within 90 days after discharge
Time frame: 90 days after discharge
Incremental Cost-Effectiveness Ratio (ICER) at Day 30
Medico-economic analysis : Incremental Cost-Effectiveness Ratio (ICER) : cost per hospitalization for Drug Adverse Event avoided and cost per all-causes hospitalization, according to a collective perspective at Day 0.
Time frame: 30 days after discharge
Incremental Cost-Effectiveness Ratio (ICER) at Day 90
Medico-economic analysis : Incremental Cost-Effectiveness Ratio (ICER) : cost per hospitalization for Drug Adverse Event avoided and cost per all-causes hospitalization, according to a collective perspective at Day 90.
Time frame: 90 days after discharge
Patient reported experience measures
Patient reported experience measures are realized by a short phone call interview, 7 days after the patients' homecoming
Time frame: 7 days after discharge
Severity of Unintended Medication Discrepancies
Severity of Unintended Medication Discrepancies intercepted during medication reconciliation at admission
Time frame: At admission
Number of Unintended Medication Discrepancies
Number of Unintended Medication Discrepancies intercepted during medication reconciliation at admission
Time frame: At admission
Impact of the implementation of the intervention on professional organizations
Qualitative analysis based on : * First, an inventory of organizations prior to the implementation of the intervention in participating health facilities * Then, an assessment of the impacts of the implementation of the intervention on different aspects of professional organizations: collaborative exchanges, multi-professional information sharing, division of labour, exchanges with city practitioners, learning effects, evolution of professional practices.
Time frame: Before and after the implementation of the intervention in the participating wards
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