Clinical trial NCT04151797: Impact of a Mobile Geriatric Team With a Pharmacist on the Optimisation of Prescriptions in Elderly Inpatients
Official title: Impact of a Mobile Geriatric Team With a Pharmacist on the Optimisation of Prescriptions in Elderly Inpatients
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Medication Therapy Management
Keywords: Medication review
clinical pharmacy
polypharmacy
older people
collaboration
inappropriate prescribing
Lead sponsor: University Hospital, Toulouse
Sponsor class: OTHER
Collaborators: name: Institut National de la Santé Et de la Recherche Médicale, France
First posted: 2019-11-05
Enrollment: 200
Sex: ALL
Minimum age (years): 75
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: SUPPORTIVE_CARE

Brief summary: 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: 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.

Eligibility criteria: 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

Primary outcomes:
measure: Change from baseline patients' number of potentially inappropriate prescription at the patient discharge after optimization by a mobile geriatric team with pharmacist
timeFrame: Month 0 and max Month 2 (At the patient discharge)
Secondary outcomes:
measure: Change from baseline patients' number of potentially inappropriate prescription at 3 months after optimization by a mobile geriatric team with pharmacist
timeFrame: Month 0, Month 3
measure: Change from baseline patients' number with at least one potentially inappropriate drug at 3 months after optimization by a mobile geriatric team with pharmacist
timeFrame: Month 0, Month 3
measure: Change from baseline ratio of potentially inappropriate drug per patient at 3 months after optimization by a mobile geriatric team with pharmacist
timeFrame: Month 0, Month 3
measure: Change from baseline mean number of medications per patient at 3 months
timeFrame: Month 0, Month 3
measure: realisation of a pharmacist-led medication review in primary care
timeFrame: Month 3
measure: number of falls 3 months after pharmacist-led medication review
timeFrame: Month 3
measure: mortality 3 months after pharmacist-led medication review
timeFrame: Month 3
measure: re-hospitalisation, including emergency room transfers
timeFrame: Month 3
measure: The nursing home transfers
timeFrame: Month 3
Other outcomes:
Locations:
city: Toulouse
country: France
facility: Toulouse University Hospital
state: Occitanie
Study officials:
affiliation: University Hospital, Toulouse
name: Philippe CESTAC, PharmD, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Pages A, Roland C, Qassemi S, Abdeljalil AB, Houles M, Romain M, Toulza O, Belloc A, McCambridge C, Voisin T, Cestac P, Juillard-Condat B; PharMoG study group. Impact of a Pharmacist-included Mobile Geriatrics team intervention on potentially inappropriate drug prescribing: protocol for a prospective feasibility study (PharMoG study). BMJ Open. 2020 Dec 2;10(12):e040917. doi: 10.1136/bmjopen-2020-040917.