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.
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.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
200
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
Toulouse University Hospital
Toulouse, Occitanie, France
Change from baseline patients' number of potentially inappropriate prescription at the patient discharge after optimization by a mobile geriatric team with pharmacist
number of potentially inappropriate prescribing per patient before (month 0) and after the intervention of the mobile geriatric team (at the patient discharge)
Time frame: Month 0 and max Month 2 (At the patient discharge)
Change from baseline patients' number of potentially inappropriate prescription at 3 months after optimization by a mobile geriatric team with pharmacist
number of potentially inappropriate prescribing per patient before (month 0) and after the intervention of the mobile geriatric team (month 3)
Time frame: Month 0, 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
number of patients with at least one potentially inappropriate drug before (month 0) and after the intervention of the mobile geriatric team (month 3)
Time frame: Month 0, Month 3
Change from baseline ratio of potentially inappropriate drug per patient at 3 months after optimization by a mobile geriatric team with pharmacist
ratio of potentially inappropriate drug per patient before (month 0) and after (month 3) the intervention of the mobile geriatric team.
Time frame: Month 0, Month 3
Change from baseline mean number of medications per patient at 3 months
Mean number of medications per patient
Time frame: Month 0, Month 3
realisation of a pharmacist-led medication review in primary care
Number of pharmacist-led medication review performed in primary care at 3 months
Time frame: Month 3
number of falls 3 months after pharmacist-led medication review
Number of falls
Time frame: Month 3
mortality 3 months after pharmacist-led medication review
Number of deaths
Time frame: Month 3
re-hospitalisation, including emergency room transfers
Number of non-scheduled hospitalisations (including emergency department transfers)
Time frame: Month 3
The nursing home transfers
Number of nursing home transfers
Time frame: Month 3
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