Inappropriate Prescribing
Conditions
Keywords
Inappropriate Prescribing, Potentially Inappropriate Medication List, Aged, Practice Guideline, Education, Medical
Brief summary
A mono-center, randomized controlled trial will be conducted at the University Hospital of Lausanne. Hospitalized patients will be randomly assigned from the emergency department to two sub-units composing the acute care for elders (ACE) unit. In one subunit, potentially inappropriate prescriptions will be detected and treatment optimized according PIM-Check. In the other, STOPP/START criteria will be independently applied.
Interventions
OTHERPIM-Check
In the PIM-Check group, a medication review will be conducted using PIM-Check within 72 hours of patient's admittance to the unit. The physician will decide whether to accept these recommendations or not and implement prescribing changes if agreed.
OTHERSTOPP/START
In the STOPP/START group, medication lists will be analyzed within 72 hours of patient's admittance and optimized according to STOPP/START criteria. The second physician will decide whether to accept these recommendations or not and implement prescribing changes if agreed.
Sponsors
Centre Hospitalier Universitaire Vaudois
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* All patients meeting the admission criteria of the acute care for elders (ACE) unit will be eligible.
Exclusion criteria
* none
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Rate of Potentially Inappropriate Prescriptions (PIPs) reduction in the PIM-Check group compared to STOPP/START | 18 months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rate of acceptability | 18 months | — |
| Number of treatment (mean and median) modification by clinicians | 18 months | — |
| Number of drugs at discharge | 18 months | — |
| Incidence rate of falls | 18 months | — |
| Number and type of PIPs detected by each tool | 18 months | — |
| Confusion Assessment Method (CAM) | 18 months | Result ranges : \[negative result (-) = no confusion\] ; \[positive result (+) = confusion\]. |
| Length of stay | 18 months | — |
| Number of unplanned readmission | up to 3 months after discharge | — |
| Association between the number and type of PIPs at discharge with rate of re-admission | up to 3 months after discharge | — |
| Activities of daily living (ADL) score | 18 months | Activities of daily living are routine activities people do every day without assistance (6 basic activities) : eating, bathing, getting dressed, toileting, transferring, and continence. The score is the number of activities performed without assistance. Score ranges : from 0/6 (minimum) to 6/6 (maximum). Higher values represent a better outcome of activities of daily living. |
Countries
Switzerland
Contacts
Primary ContactChantal Csajka, PharmD, PhD
Backup ContactAkram FARHAT, PharmD, MPH, PhD
Outcome results
None listed