Guaranteeing the Continuity of the Care Pathway for the Elderly Patient: Evaluation of a Territorial Approach of Clinical Pharmacy

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

Official Title
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Eval CONPARMED Haute-Bretagne : Guaranteeing the Continuity of the Care Pathway for the Elderly Patient: Evaluation of a Territorial Approach of Clinical Pharmacy

Conditions
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Medication Reconciliation at Discharge

Intervention / Treatment
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* Other: medication reconciliation


Participation Criteria
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Eligibility Criteria
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Inclusion criteria : Patient > 65 years old Patient hospitalized inside one of the thirteen wards in the 6 hospitals participating in the study Informed consent given Non inclusion and Exclusion Criteria : Patients in palliative care Persons deprived of their liberty

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| MR group<br>Patients who benefit from a full process of medication reconciliation (entrance and discharge) before being discharged to home. | Other: medication reconciliation<br>* 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).<br>|
| Control group<br>Patients who benefitted from a medication reconciliation at entrance only before being discharged to home. | Other: medication reconciliation<br>* 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).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Adverse drug event-related hospital revisits | Rate of adverse drug event-related hospital revisits within 30 days after discharge | 30 days after discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| General Practitioner consultation | Rate of General Practitioner consultation within 30 days after discharge | 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 | 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 | 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. | 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. | 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 | 7 days after discharge | 
| Severity of Unintended Medication Discrepancies | Severity of Unintended Medication Discrepancies intercepted during medication reconciliation at admission | At admission | 
| Number of Unintended Medication Discrepancies | Number of Unintended Medication Discrepancies intercepted during medication reconciliation at admission | 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. | Before and after the implementation of the intervention in the participating wards | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Medication reconciliation, clinical pharmacy