Impact of a Mobile Geriatric Team With a Pharmacist on the Optimisation of Prescriptions in Elderly Inpatients

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

Official Title
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Impact of a Mobile Geriatric Team With a Pharmacist on the Optimisation of Prescriptions in Elderly Inpatients

Conditions
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Medication Therapy Management

Intervention / Treatment
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* Other: Medication therapy management


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient aged 75 or older Having 5 medications or more per day Being hospitalised either in emergency room, short-stay medicine unit or surgery department Exclusion Criteria: Patient refuses to participate Patient already included in another study

Ages Eligible for Study
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Minimum Age: 75 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: Supportive Care
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Medication therapy management<br>Medication therapy management by pharmacist-led medication review | Other: Medication therapy management<br>* 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<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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) | Month 0 and max Month 2 (At the patient discharge) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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) | 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) | 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. | Month 0, Month 3 | 
| Change from baseline mean number of medications per patient at 3 months | Mean number of medications per patient | 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 | Month 3 | 
| number of falls 3 months after pharmacist-led medication review | Number of falls | Month 3 | 
| mortality 3 months after pharmacist-led medication review | Number of deaths | Month 3 | 
| re-hospitalisation, including emergency room transfers | Number of non-scheduled hospitalisations (including emergency department transfers) | Month 3 | 
| The nursing home transfers | Number of nursing home transfers | Month 3 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Medication review, clinical pharmacy, polypharmacy, older people, collaboration, inappropriate prescribing