Chronic Disease
Conditions
Keywords
Drug Safety, Clinical Pharmacy, General Practice, Surgery, Geriatrics, Medication Review
Brief summary
The presence of a clinical pharmacist (for their pharmacological expertise) and a general practitioner (for their somatic expertise) in surgery departments would contribute to improve the management of medications in elderly patients.
Interventions
OTHERMutlidisciplinary medication Review (MMR)
The clinical pharmacist performs medication reconciliation and pharmaceutical analysis. The physician performs a clinical examination and analysis of the medical record. Both participate in a collaborative interview. The hospital physician calls the community pharamcist to discuss proposed changes on the order and to establish a new prescription. At the end of the stay, the clinical pharmacist will conduct an exit interview with the patient. Three months after discharge, the patient's community pharmacist will be contacted to assess whether the changes proposed in the MMR were accepted
OTHERMutlidisciplinary medication Review (MMR) with community pharmacist follow-up
Multidisciplinary medication review (MMR) The clinical pharmacist performs medication reconciliation and pharmaceutical analysis. The physician performs a clinical examination and analysis of the medical record. Both participate in a collaborative interview. The hospital physician calls the community physician to discuss proposed changes on the order and to establish a new prescription. At the end of the stay, the clinical pharmacist will conduct an exit interview with the patient. Community follow-up A summary of the follow-up report stating the therapeutic modifications (called below multidisciplinary correspondence documents) will be sent to the community pharmacist and physician. Within 2 months of discharge, the pharmacist performs a follow-up of medication changes accepted and not accepted by the community physician. Three months after discharge, the patient's community pharmacist will be contacted to assess whether the changes proposed in the MMR were accepted.
Sponsors
Centre Hospitalier Universitaire de Nīmes
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* The patient (or their representative) has given his consent and signed the consent form. * The patient is affiliated to a health insurance programme. * The patient is at least 65 years old (≥) treated by at least (≥) five medications for at least (≥) 6 months * The patient is available for a follow-up of 3 months. * The patient is hospitalized in the surgery department. * Patient with a Trivalle score greater than or equal to 2 (≥). * Patient living in a nursing home or going back home after hospitalization.
Exclusion criteria
* The subject is participating in another category I interventional study. * The subject is in an exclusion period determined by another study. * The subject is under safeguard of justice. * It is not possible to give the patient (or his/her trusted-person) informed information. * Palliative care
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in iatrogenic drug risk in intervention groups versus control group | 3 months after hospitalization | Proportion of patients transitioning from intermediate or high to low risk according to Trivalle score (a score between 0-10. A score 0-1 constitutes a low ADE risk (12%), score 2-5 represents an average risk (32%), and a score 6-10 represents a high risk (53%) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of potentially inappropriate medications per patient in each group | Hospital discharge (maximum 30 days) | — |
| Proportion of proposed medication modifications made by the collaborative team accepted and/or made permanent | 3 months after hospital discharge | Number of modifications accepted/number of modifications proposed |
| Time required for Multidisciplinary Medication Review in the interventional groups (B1 and B2) | Hospital discharge (maximum 30 days) | Hours |
| Time required for ransmitting multidisciplinary correspondence documents in B2 group | Hospital discharge (maximum 30 days) | Hours |
| Number of multidisciplinary correspondence documents sent to the community acotors in B2 group | Hospital discharge (maximum 30 days) | — |
| Description of mode of diffusion of multidisciplinary correspondence documents in the B2 group | Hospital discharge (maximum 30 days) | email, fax or letter |
| Proportion of proposed medication modifications made by the clinical pharmacist accepted by the clinical doctor during the Multidisciplinary Medication Review in the experimental groups | Hospital discharge (maximum 30 days) | Number of modifications accepted/number of modifications proposed |
| Rate of patients for whom a follow-up review of proposed medication changes has been performed by the pharmacist in the B2 group | 2 months post discharge | — |
| Number of multidisciplinary correspondence documents transmitted by community pharmacist in group B2 | 2 months post hospital discharge | — |
| Rate of patients with at least one rehospitalization in each group | 3 months after hospital discharge | — |
| Mortality rate in each group | 3 months after hospital discharge | — |
| Healthcare team satisfaction in interventional groups (B1, B2) | 3 months after hospital discharge | Custom-built 7-part questionnaire |
| patient satisfaction in all groups (A, B1, B2) | 3 months after hospital discharge | questionnaire |
| Description of reason for non-transmission of multidisciplinary correspondence documents in the B2 group | Hospital discharge (maximum 30 days) | — |
Countries
France
Contacts
Primary ContactJean-Marie Kinowski
Outcome results
None listed