Impact of Mulstidisciplinary Medication Assessment Review in Surgery Departments

Study Overview
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Brief Summary
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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.

Official Title
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Implementation and Impact of Multidisciplinary Medication Review in Surgery Departments on Medication Management of Elderly Patients

Conditions
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Chronic Disease

Intervention / Treatment
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* Other: Mutlidisciplinary medication Review (MMR)
* Other: Mutlidisciplinary medication Review (MMR) with community pharmacist follow-up


Participation Criteria
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Eligibility Criteria
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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

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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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control group<br> | |
| Experimental: B1 interventional group<br> | Other: Mutlidisciplinary medication Review (MMR)<br>* 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<br>|
| Experimental: B2 interventional group<br> | Other: Mutlidisciplinary medication Review (MMR)<br>* 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<br>Other: Mutlidisciplinary medication Review (MMR) with community pharmacist follow-up<br>* 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.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in iatrogenic drug risk in intervention groups versus control group | 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%) | 3 months after hospitalization | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of proposed medication modifications made by the clinical pharmacist accepted by the clinical doctor during the Multidisciplinary Medication Review in the experimental groups | Number of modifications accepted/number of modifications proposed | Hospital discharge (maximum 30 days) | 
| 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 | Number of modifications accepted/number of modifications proposed | 3 months after hospital discharge | 
| Number of potentially inappropriate medications per patient in each group |  | 3 months after hospital discharge | 
| Time required for Multidisciplinary Medication Review in the interventional groups (B1 and B2) | Hours | Hospital discharge (maximum 30 days) | 
| Time required for ransmitting multidisciplinary correspondence documents in B2 group | Hours | Hospital discharge (maximum 30 days) | 
| 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 | email, fax or letter | Hospital discharge (maximum 30 days) | 
| Description of reason for non-transmission of multidisciplinary correspondence documents in the B2 group |  | Hospital discharge (maximum 30 days) | 
| 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) | Custom-built 7-part questionnaire | 3 months after hospital discharge | 
| patient satisfaction in all groups (A, B1, B2) | questionnaire | 3 months after hospital discharge | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Drug Safety, Clinical Pharmacy, General Practice, Surgery, Geriatrics, Medication Review