Clinical trial NCT05327634: Obstacles to Deprescribing Among French Patients Over 75 Years of Age Treated in the Geriatric Hospital Network
Official title: Description of the Obstacles to Deprescribing Among French Patients Over 75 Years of Age Treated in the Geriatric Hospital Network
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Medication Abuse
Keywords: Elderly patient
Inappropriate drugs
Deprescribing
Obstacles
French
Lead sponsor: Hôpital NOVO
Sponsor class: OTHER
First posted: 2022-04-14
Enrollment: 120
Sex: ALL
Minimum age (years): 75
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Patients aged 75 and over hospitalised in geriatric short stay or geriatric rehabilitation units

Brief summary: The aim of this study is to highlight action guidelines to encourage acceptance of deprescribing in people over 75 years of age: training, therapeutic education, post-prescription follow-up, specific patient pathways, specific consultations or even the integration of an advanced practice nurse in this process.

Detailed description: For several years now, the proportion of senior citizens in our country has been rising steadily. There are now 6.4 million people over the age of 75 in France.

It is therefore important to take into account the needs and specificities of this part of the population. One of its particularities is polypathology. Indeed, from the age of 70 onwards, 93% of elderly subjects have at least 2 diseases and 85% have at least 3. This polypathology will lead to a large number of different prescribers with an increased risk of having more than 5 molecules in their personal treatment. This is known as polypharmacy.

In the elderly, polypharmacy is harmful. It increases the risk of adverse effects and drug interactions. In France, 20% of patients over 75 years old and 25% of those over 85 years old consult the emergency room because of adverse drug reactions.

The literature shows that we can act on these adverse events by "deprescribing". De-prescribing is defined as intentionally stopping the prescription of an unnecessary or potentially dangerous drug for a patient.

The expected benefit for the patient is to reduce the iatrogenic risks induced by treatments that would no longer be useful for him/her or that have a negative benefit/risk balance. To achieve this objective, the patient must understand this risk, understand the benefit he or she can derive from it and be an actor in this process.

For carers, the expected benefit is greater involvement of the patient in the process, better adherence to the approach, which can be organised and carried out in a safer way.

Eligibility criteria: Inclusion Criteria:

* Patients aged 75 years and over
* Hospitalized in geriatric short-stay or geriatric rehabilitation units
* Patients who did not object to participation in the study

Exclusion Criteria:

* Patient refusal
* Patients not able to understand and fill in the questionnaire: Cognitive disorders, Confusion, Unstable clinical state, Sensory disorders, not speaking French.
* Patient under protective supervision (guardianship or curatorship)

Primary outcomes:
measure: Description of the obstacles to the withdrawal of medication in patients over 75 years of age in the geriatric sector
timeFrame: Baseline
Secondary outcomes:
measure: Assessment of the relationship between patient burden and acceptance (or refusal) of deprescribing.
timeFrame: Baseline
measure: Assessment of the relationship between the benefit of the treatment experienced by the patient and the acceptance (or refusal) of the deprescribing
timeFrame: Baseline
measure: Assessment of the relationship between concern about possible negative effects of discontinuing treatment and acceptance (or refusal) of deprescribing
timeFrame: Baseline
measure: Assessment of the relationship between the patient's good knowledge of their treatments and acceptance (or refusal) of the deprescribing.
timeFrame: Baseline
measure: Assessment of the relationship between certain families of treatments and acceptance (or refusal) of deprescribing
timeFrame: Baseline
Other outcomes:
Locations:
city: Beauvais
country: France
facility: Short stay Geriatric department - Hospital Simone Veil
city: Beauvais
country: France
facility: SSR Geriatric department - Hospital Simone Veil
city: Pontoise
country: France
facility: Short stay Geriatric department - Hospital René Dubos
city: Pontoise
country: France
facility: SSR Geriatric department - Hospital René Dubos
Study officials:
affiliation: Hospital René Dubos
name: Christophe Antoniazzi
role: PRINCIPAL_INVESTIGATOR
References:
citation: Roux B, Sirois C, Niquille A, Spinewine A, Ouellet N, Petein C, Sibille FX, Csajka C, Reeve E, Villeneuve C, Laroche ML. Cross-cultural adaptation and psychometric validation of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire in French. Res Social Adm Pharm. 2021 Aug;17(8):1453-1462. doi: 10.1016/j.sapharm.2020.11.004. Epub 2020 Nov 10.