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Mati E, Mioux L, Ollagnier G, Waissi A, Benzerdjeb N, Messaoudi K, De La Gastine B, Aouni F, Ahmine S, Leperre A, Bleyzac N. How could proton pump inhibitors de-prescription be managed in geriatric long-term care? Therapie 2024:S0040-5957(24)00064-7. [PMID: 38908995 DOI: 10.1016/j.therap.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/11/2024] [Accepted: 05/13/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Evaluate the misuse of proton pump inhibitors (PPIs) in geriatric long-term care (LTC) patients and improve caregiving by de-prescribing non-relevant PPIs in this population. AIM This study was conducted in the long-term care department of the geriatric hospital Pierre-Garraud in Lyon. All patients receiving PPI for more than 8 weeks were included. A reassessment form was filled to evaluate the treatment benefit/risk ratio during a collegial consultation between the patient's referring physicians and pharmacists. During these consultations, the following possible decisions were taken: continuation, dose adjustment or gradual discontinuation of treatment. Patients' monitoring were performed one month and three months after discontinuation to detect any relapses and causes. RESULTS Among the 113 patients included, 97 patients had their treatment re-evaluated by collegial consultation. Forty-four (45.4%) patients were treated in accordance with recommendations. For 24 of them, the indication was symptomatic recurrent gastroesophageal reflux disease. The treatment of more than half of the re-evaluated patients (54.6%) was gradually stopped. After the 3-month follow-up post-discontinuation, excluding patients who died during this period, 80.9% of the discontinuations were well-tolerated and only nine were resumed (19.1%). CONCLUSION This study allowed a re-evaluation of PPI treatments in a high-risk population and offered a decision support tool focused on the benefit/risk balance of PPIs; 55% of treatments were considered irrelevant and could be stopped with 80% of good tolerance.
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Affiliation(s)
- Elma Mati
- Hôpital Pierre-Garraud, hospices civils de Lyon, 69000 Lyon, France
| | - Lisa Mioux
- Hôpital Pierre-Garraud, hospices civils de Lyon, 69000 Lyon, France
| | - Grégoire Ollagnier
- Geriatric long-term care medicine, hôpital Pierre-Garraud, hospices civils de Lyon, 69000 Lyon, France
| | - Aziza Waissi
- Geriatric long-term care medicine, hôpital Pierre-Garraud, hospices civils de Lyon, 69000 Lyon, France
| | - Nacera Benzerdjeb
- Geriatric long-term care medicine, hôpital Pierre-Garraud, hospices civils de Lyon, 69000 Lyon, France
| | - Karima Messaoudi
- Geriatric long-term care medicine, hôpital Pierre-Garraud, hospices civils de Lyon, 69000 Lyon, France
| | - Blandine De La Gastine
- Geriatric long-term care medicine, hôpital Pierre-Garraud, hospices civils de Lyon, 69000 Lyon, France
| | - Fayçal Aouni
- Geriatric long-term care medicine, hôpital Pierre-Garraud, hospices civils de Lyon, 69000 Lyon, France
| | - Sabiha Ahmine
- Geriatric long-term care medicine, hôpital Pierre-Garraud, hospices civils de Lyon, 69000 Lyon, France
| | - Armelle Leperre
- Geriatric long-term care medicine, hôpital Pierre-Garraud, hospices civils de Lyon, 69000 Lyon, France
| | - Nathalie Bleyzac
- Pharmacy department, hôpital Pierre-Garraud, hospices civils de Lyon, 69000 Lyon, France.
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Corvaisier M, Brangier A, Annweiler C, Spiesser-Robelet L. Preventable or potentially inappropriate psychotropics and adverse health outcomes in older adults: systematic review and meta-analysis. J Nutr Health Aging 2024; 28:100187. [PMID: 38341965 DOI: 10.1016/j.jnha.2024.100187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/31/2024] [Accepted: 01/31/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE To systematically review and quantitatively synthetize evidence on the use of PIPs linked to adverse health outcomes in older adults. METHODS A Medline, Embase® and Opengrey libraries search was conducted from 2004 to February 2021, using the PICO model: older people, psychotropic drugs, inappropriate prescribing, and adverse drug events. Fixed-effects and random-effects meta-analysis were performed from 3 eligible studies using an inverse-variance method. RESULTS Of the 1943 originally identified abstracts, 106 met the inclusion criteria and 7 studies were included in this review. All were of good quality. The number of participants ranged from 318 to 383,150 older adults (54.5-74.4% women). Associations were found between PIPs use and decreased personal care activities of daily living (ADL), unplanned hospitalizations, falls and mortality. In the pooled analysis, association with falls was confirmed (1.23 [95%CI: 1.15;1.32]). CONCLUSIONS Participants of 65 years and older treated with PIPs were more at risk of adverse health outcomes than those using no PIPs, including greater risks of falls, functional disabilities, unplanned hospitalizations, and mortality. Results of the present systematic review and meta-analysis provide additional evidence for an appropriate and safe use of psychotropics in older adults.
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Affiliation(s)
- Mathieu Corvaisier
- UNIV ANGERS, School of Pharmacy, Health Faculty, University of Angers, 49045 Angers, France; UNIV ANGERS, EA4638, University of Angers, 49100 Angers, France; Department of Geriatric Medicine, Research Center on Autonomy and Longevity, University Hospital, 49933 Angers, France; Department of Pharmacy, Angers University Hospital, 49933 Angers, France.
| | - Antoine Brangier
- Department of Geriatric Medicine, Research Center on Autonomy and Longevity, University Hospital, 49933 Angers, France
| | - Cédric Annweiler
- UNIV ANGERS, EA4638, University of Angers, 49100 Angers, France; Department of Geriatric Medicine, Research Center on Autonomy and Longevity, University Hospital, 49933 Angers, France; UNIV ANGERS, School of Medicine, Health Faculty, University of Angers, 49045 Angers, France; Gerontopôle of Pays de la Loire, 44000 Nantes, France
| | - Laurence Spiesser-Robelet
- UNIV ANGERS, School of Pharmacy, Health Faculty, University of Angers, 49045 Angers, France; Department of Pharmacy, Angers University Hospital, 49933 Angers, France; EA 3412 Health Education and Promotion Laboratory, University of Sorbonne Paris Nord, 93017 Bobigny, France
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Schwab C, Clementz A, Dechartres A, Fernandez C, Hindlet P. Are Lists of Potentially Inappropriate Medications Associated with Hospital Readmissions? A Systematic Review. Drugs Aging 2024; 41:209-218. [PMID: 38273186 DOI: 10.1007/s40266-024-01099-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Suboptimal prescribing, including the prescription of potentially inappropriate medications (PIM), is frequent in patients aged 65 years and older. PIMs are associated with adverse drug events, which may lead to hospital admissions and readmissions for the most serious cases. Several tools, known as lists of PIMs, can detect suboptimal prescription. OBJECTIVE This systematic review aimed to identify which lists of PIMs are associated with hospital readmission of older patients. PATIENTS AND METHODS MEDLINE, the Cochrane Library, EMBASE, and clinicaltrials.gov were searched for the period from 1 January 1991 up to 12 May 2022 to identify original studies assessing the association between PIMs and hospital readmissions or emergency department (ED) revisits within 30 days of discharge in older patients. This study is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Checklist, and the risk of bias was assessed with the Newcastle-Ottawa Quality Assessment Scale for Cohort Studies (NOS) and the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). RESULTS A total of six studies presenting four different lists of PIMs were included. Readmission rates varied from 4.3 to 25.5% and the odds ratio (OR) between PIMs and hospital readmission varied from 0.92 [95% confidence interval (CI) 0.59; 1.42] to 6.48 [95% CI 3.00; 14.00]. Only two studies found a statistically significant association between a list of PIMs and hospital readmission. These two studies used different tools: the Screening Tool of Older Person's Prescriptions (STOPP) and the Screening Tool to Alert Doctors to Right Treatment (START) and a combination of Beers Criteria® and STOPP and START. CONCLUSION This systematic review shows that the association between list of PIMs and 30-day unplanned readmissions remains unclear and seems dependent on the PIM detection tool. Further studies are needed to clarify this association. PROSPERO registration number CRD42021252107.
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Affiliation(s)
- Camille Schwab
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, 75012, Pharmacie, Paris, France.
- Université Paris Saclay, Faculté de Pharmacie, Département de Pharmacie clinique, Orsay, France.
| | - Alice Clementz
- Université Paris Saclay, Faculté de Pharmacie, Département de Pharmacie clinique, Orsay, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Sainte-Périne, Pharmacie, Paris, France
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France
| | - Christine Fernandez
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, 75012, Pharmacie, Paris, France
- Université Paris Saclay, Faculté de Pharmacie, Département de Pharmacie clinique, Orsay, France
| | - Patrick Hindlet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, 75012, Pharmacie, Paris, France
- Université Paris Saclay, Faculté de Pharmacie, Département de Pharmacie clinique, Orsay, France
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Rahuel C, Pautrat M, Aïdoud A, Fougère B, Debacq C. Providing information about medication changes upon discharge from a geriatric unit: the community healthcare professionals' point of view. BMC Geriatr 2024; 24:39. [PMID: 38195469 PMCID: PMC10775557 DOI: 10.1186/s12877-023-04551-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 11/30/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION It is well known that polypharmacy is associated with adverse drug events. Accordingly, specialist geriatric units have to pay particular attention to the appropriateness of prescription and the withdrawal of potentially inappropriate medications. Even though community healthcare professionals are keen to received medication reconciliation results, the literature data show that the quality of communication between the hospital and the community needs to be improved. OBJECTIVE To assess community healthcare professionals' opinions about the receipt of medication reconciliation results when a patient is discharged from a specialist geriatric unit. METHOD We performed a qualitative study of general practitioners, community pharmacists and retirement home physicians recruited by phone in the Indre-et-Loire region of France. A grounded theory method was used to analyze interviews in multidisciplinary focus groups. RESULTS The 17 community healthcare professionals first explained why the receipt of medication reconciliation results was important to them: clarifying the course and outcomes of hospital stays and reducing the lack of dialogue with the hospital, so that the interviewees could provide the care expected of them. The interviewees also described mistrust of the hospital and uncertainty when the modifications were received; these two concepts accentuated each other over time. Lastly, they shared their opinions about the information provided by the hospital, which could improve patient safety and provide leverage for treatment changes but also constituted a burden. PERSPECTIVES Our participants provided novel feedback and insight, constituting the groundwork for an improved medication reconciliation form that could be evaluated in future research. Exploring hospital-based professionals' points of view might help to determine whether the requested changes in the medication reconciliation form are feasible and might provide a better understanding of community-to-hospital communication.
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Affiliation(s)
- Céline Rahuel
- Division of Geriatric Medicine, Tours University Hospital, 37000, Tours, France.
| | - Maxime Pautrat
- Department of General Practice, Tours University Hospital, 37000, Tours, France
- EA7505 (Education, Ethics, Health), University of Tours, Tours, France
| | - Amal Aïdoud
- Division of Geriatric Medicine, Tours University Hospital, 37000, Tours, France
- EA4245 (Transplantation, Immunology, Inflammation), University of Tours, Tours, France
| | - Bertrand Fougère
- Division of Geriatric Medicine, Tours University Hospital, 37000, Tours, France
- EA7505 (Education, Ethics, Health), University of Tours, Tours, France
| | - Camille Debacq
- Division of Geriatric Medicine, Tours University Hospital, 37000, Tours, France
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Schulze Westhoff M, Schröder S, Heck J, Brod T, Winkelmann M, Bleich S, Frieling H, Jahn K, Wedegärtner F, Groh A. Drug Safety Profiles of Geriatric Patients Referred to Consultation Psychiatry in the Emergency Department-A Retrospective Cohort Study. J Geriatr Psychiatry Neurol 2023; 36:407-416. [PMID: 36592403 PMCID: PMC10394965 DOI: 10.1177/08919887221149158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Geriatric patients account for a significant proportion of the collective treated by psychiatric consultation service in hospitals. In the Emergency Department (ED), psychotropic drugs are frequently recommended, notwithstanding their extensive side-effect profiles. This study sought to investigate medication safety of geriatric patients referred to psychiatric consultation service in the ED. METHODS Medication lists of 60 patients from the general internal medicine and trauma surgery EDs referred to psychiatric consultation service were analyzed. Utilizing PRISCUS list and Fit fOR The Aged (FORTA) classification, prescriptions of potentially inappropriate medications (PIMs) were assessed. RESULTS 84 drugs were newly prescribed following psychiatric consultations. The total number of drugs per patient was 5.4 ± 4.2 before psychiatric consultation and 6.5 ± 4.2 thereafter (p < .001). 22.6 % of the newly recommended drugs were PIMs according to the PRISCUS list, while 54.8 % were designated as therapeutic alternatives to PIMs. 54.8 % and 20.2 % of the newly recommended drugs were FORTA category C and D drugs, respectively. An average of 1.2 ± 1.7 drug-drug interactions (DDIs) existed before psychiatric consultation and 1.3 ± 1.9 DDIs thereafter (p = .08). CONCLUSION The majority of newly recommended drugs by psychiatric consultation service in the ED were designated as suitable therapeutic alternatives to PIMs according to the PRISCUS list, but had comparatively unfavorable ratings according to the FORTA classification, demonstrating discrepancies between these two PIM classification systems. Physicians delivering psychiatric consultation services in the ED should not solely rely on one PIM classification system.
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Affiliation(s)
- Martin Schulze Westhoff
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Sebastian Schröder
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Johannes Heck
- Institute for Clinical Pharmacology, Hannover Medical School, Hannover, Germany
| | - Torben Brod
- Emergency Department, Hannover Medical School, Hannover, Germany
| | | | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Kirsten Jahn
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Felix Wedegärtner
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Adrian Groh
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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Coulongeat M, Polisset N, Poitau F, Laurent E, Fougère B, Lemaignen A. Inter-expert agreement on indications for antibiotic therapy in older adults admitted to French hospital through an emergency department. Heliyon 2022; 8:e11630. [PMID: 36411926 PMCID: PMC9674905 DOI: 10.1016/j.heliyon.2022.e11630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/02/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Around one third of older adults with infections have an atypical presentation upon admission to an emergency department (ED). Objective To evaluate the level of agreement between experts from several disciplines on the indication for antibiotic therapy for a bacterial infection in older patients presenting at an ED, and to describe the characteristics of the infections. Methods Based on comprehensive medical records, three experts (a geriatrician, an emergency physician (EP), and an infectious disease specialist (IDS)) determined independently and then jointly whether a patient presenting at the ED had a bacterial infection requiring antibiotic therapy. Inter-expert agreement was expressed as a fixed-marginal Fleiss’ kappa (κ). Results Of the 444 medical records included, the consensus meeting found that 114 (25.7%) had an indication for antibiotics, 327 (73.6%) did not have an indication, and 3 could not be classified. The overall level of agreement was 85.2%, and κ[95%CI] was 0.64 [0.57–0.72] (p < 0.001). The level of agreement between the geriatrician and the IDS (89.41%, κ0.73, 95%CI [0.62–0.85] (p < 0.001)) was higher than that between the geriatrician and the EP (83.56%, κ0.62, 95%CI [0.51–0.73] (p < 0.001)) and between the IDS and the EP (82.66%, κ0.59, 95%CI [0.48–0.70] (p < 0.001)). The levels of agreement between the final adjudication, was higher for the geriatrician, and IDS respectively 94.1% (κ0.85, 95%CI [0.74–0.97] (p < 0.001) and 94.4% (κ0.86, 95%CI [0.74–0.97] (p < 0.001)). 114 (25.7%) patients had a bacterial infection (mostly lung infections (n = 55, 48.2%) and urinary tract infections (n = 25, 21.9%)), and 28 patients (6.3%) had a viral infection. Conclusion Our results highlighted substantial agreement between members of a multidisciplinary expert panel. Experts from different disciplines showed substantial agreement in deciding on the requirement of antibiotics The level of inter-expert agreement depended on the physicians' medical specialties Most of the bacterial infections were lung infections and urinary tract infections This study is the first step towards to better identification of infections with an atypical presentation of infections
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Frequency, Characteristics, and Predictive Factors of Adverse Drug Events in an Adult Emergency Department according to Age: A Cross-Sectional Study. J Clin Med 2022; 11:jcm11195731. [PMID: 36233599 PMCID: PMC9572040 DOI: 10.3390/jcm11195731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/18/2022] Open
Abstract
Adverse drug events (ADEs) are a major public health concern, given their consequences in terms of morbi-mortality and associated healthcare costs. Many studies have focused on the elderly, who are considered particularly vulnerable in this respect. We aimed to determine and compare the frequency, characteristics, and predictive factors of ADEs according to age in an adult population. A prospective seven-year cross-sectional study was conducted in a university hospital emergency department. Structured medication reviews and ADE detection were performed. Patient data and ADE characteristics were collected. Descriptive statistics and logistic regression were performed in two age groups: Group 1 (age < 65 years) and 2 (age ≥ 65 years). Among the 13,653 patients included, 18.4% in Group 1 and 22.6% in Group 2 experienced an ADE. Differences were identified in terms of the ADE type (more ADEs due to noncompliance in Group 1) and ADE symptoms (greater bleeding in Group 2). In the multivariable analysis, several specific predictive factors were identified, including kidney failure and antidiabetic drug use in Group 1 and inappropriate prescription and antithrombotic treatment in Group 2. Analysis by age provided a more refined vision of ADEs as we identified distinct profiles of iatrogenesis. These results will lead to a better detection of ADEs.
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De la conciliation médicamenteuse au bilan partagé de médication : Etude pilote intégrant un accompagnement des pharmaciens d’officine au sein d’un parcours de soins pharmaceutiques. ANNALES PHARMACEUTIQUES FRANÇAISES 2022; 80:950-960. [DOI: 10.1016/j.pharma.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 01/28/2022] [Accepted: 02/22/2022] [Indexed: 11/23/2022]
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Chappe M, Corvaisier M, Brangier A, Annweiler C, Spiesser-Robelet L. Impact of the COVID-19 pandemic on drug-related problems and pharmacist interventions in geriatric acute care units. ANNALES PHARMACEUTIQUES FRANÇAISES 2021; 80:669-677. [PMID: 34968479 PMCID: PMC8711174 DOI: 10.1016/j.pharma.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 12/13/2021] [Accepted: 12/21/2021] [Indexed: 11/18/2022]
Abstract
Objectives To assess and compare the pharmaceutical analysis on drug management in a geriatric acute care unit prior to and during the COVID-19 pandemic. Methods This was a single-centre, retrospective, and comparative cohort study. All Pharmacist Interventions (PIs) carried out in the unit between 27 January 2020 and 30 April 2020 were distinguished according to whether they were conducted prior to or during the first wave of COVID-19. The main outcome measure was the rate of PIs per patient and per prescription lines analysed. Other data collected were the drug class managed by the PI, the Drug Related Problems (DRP) identified, the nature of the advice given, and the acceptance rate by geriatricians. Results A total of 355 patients were analysed, with PIs generated for 21.7% of the patients prior to COVID-19, and for 53.4% of the patients during the first wave (p < 0.001). Among the 4402 prescription lines analysed, 54 PIs were carried out for prescriptions prior to COVID-19, and 177 during the first wave (p = 0.002). DRPs were mostly related to anti-infectious drugs during the pandemic (20.3%, p = 0.038), and laxatives prior to the pandemic (13.0%, p = 0.023). The clinical impact of the PIs was mainly moderate (43.7%). The acceptance rate was 59.3%. Conclusions A greater amount of DRPs were detected and more therapeutic advice was proposed during the first wave of COVID-19, with a focus on drugs used for the management of COVID-19 rather than geriatric routine treatments. The needs for clinical pharmacists were strengthened during the pandemic.
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Affiliation(s)
- M Chappe
- Department of Pharmacy, Angers University Hospital, Angers, France; Department of Geriatric Medicine, Research Center on Autonomy and Longevity, Angers University Hospital, Angers, France; Department of Pharmacy, Haut Anjou Hospital, Chateau-Gontier, France.
| | - M Corvaisier
- Department of Pharmacy, Angers University Hospital, Angers, France; Department of Geriatric Medicine, Research Center on Autonomy and Longevity, Angers University Hospital, Angers, France; UPRES EA 4638, University of Angers, Angers, France
| | - A Brangier
- Department of Geriatric Medicine, Research Center on Autonomy and Longevity, Angers University Hospital, Angers, France
| | - C Annweiler
- Department of Geriatric Medicine, Research Center on Autonomy and Longevity, Angers University Hospital, Angers, France; UPRES EA 4638, University of Angers, Angers, France; Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, the University of Western Ontario, London, Ontario, Canada
| | - L Spiesser-Robelet
- Department of Pharmacy, Angers University Hospital, Angers, France; Health Education and Practices Laboratory-LEPS (EA 3412), Paris13-Sorbonne Paris Cité University, Bobigny, France
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10
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Assessment of Prescriptions in Elderly Patients Hospitalized in Medicine Departments. J Clin Med 2021; 10:jcm10225343. [PMID: 34830625 PMCID: PMC8621875 DOI: 10.3390/jcm10225343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/29/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022] Open
Abstract
Drug-related iatrogenesis is an important issue in the elderly population, and preventing iatrogenic accidents helps to reduce hospitalizations. Our study’s objective was to evaluate prescriptions in the geriatric population of our establishment. The study conducted is a targeted clinical audit. Ten criteria were tested on the hospital prescriptions of people over 75 years old in 11 medical departments, before and after improvement actions. The non-compliance threshold was set at 10% of prescriptions for each criterion. In each phase, 165 patients were included. Four criteria were non-compliant (NC) in the first phase: the presence of Potentially Inappropriate Medications for the Elderly (PIMs) (NC = 57.6%), the adaptation of the medication to renal clearance (NC = 24.9%), the presence of illogical combination (NC = 9.7%), and the total anti-cholinergic score of the prescription (NC = 12.1%). After the implementation of improvement actions, the number of non-compliant criteria decreased between the two phases, from four to two. We obtained a significant improvement for three of the four criteria found to be non-compliant in the first phase. The criterion adaptation to renal function is close to compliance (NC = 10.1%) and the PIMs criterion remained non-compliant after reassessment (NC = 32.1%). Vigilance must be ongoing in order to limit drug iatrogeny, particularly in frail elderly patients.
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Damy T, Chouihed T, Delarche N, Berrut G, Cacoub P, Henry P, Lamblin N, Andrès E, Hanon O. Diagnosis and Management of Heart Failure in Elderly Patients from Hospital Admission to Discharge: Position Paper. J Clin Med 2021; 10:jcm10163519. [PMID: 34441815 PMCID: PMC8396904 DOI: 10.3390/jcm10163519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 02/07/2023] Open
Abstract
Multidisciplinary management of worsening heart failure (HF) in the elderly improves survival. To ensure patients have access to adequate care, the current HF and French health authority guidelines advise establishing a clearly defined HF patient pathway. This pathway involves coordinating multiple disciplines to manage decompensating HF. Yet, recent registry data indicate that insufficient numbers of patients receive specialised cardiology care, which increases the risk of rehospitalisation and mortality. The patient pathway in France involves three key stages: presentation with decompensated HF, stabilisation within a hospital setting and transitional care back out into the community. In each of these three phases, HF diagnosis, severity and precipitating factors need to be promptly identified and managed. This is particularly pertinent in older, frail patients who may present with atypical symptoms or coexisting comorbidities and for whom geriatric evaluation may be needed or specific geriatric syndrome management implemented. In the transition phase, multi-professional post-discharge management must be coordinated with community health care professionals. When the patient is discharged, HF medication must be optimised, and patients educated about self-care and monitoring symptoms. This review provides practical guidance to clinicians managing worsening HF in the elderly.
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Affiliation(s)
- Thibaud Damy
- Service de Cardiologie, CHU H. Mondor, 94000 Créteil, France
- Correspondence:
| | - Tahar Chouihed
- Service des SAMU-SMUR-Urgences, Centre d’Investigations Cliniques-1433, INSERM UMR_S 1116, Université de Lorraine, CHRU Nancy, F-CRIN INI-CRCT, 541000 Nancy, France;
| | | | - Gilles Berrut
- CHU Nantes, Pôle Hospitalo-Universitiare de Gérontologie Clinique, 44000 Nantes, France;
| | - Patrice Cacoub
- Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, AP-HP, 75000 Paris, France;
| | - Patrick Henry
- Service de Cardiologie, APHP, Hôpital Lariboisière, 75000 Paris, France;
| | - Nicholas Lamblin
- Service de Cardiologie, Institut Pasteur de Lille, CHU de Lille, Université de Lille, U1167, 59000 Lille, France;
| | - Emmanuel Andrès
- Service Méd. Interne, Diabète, Maladies Métaboliques, Clinique Médicale B, CHU Strasbourg, 67000 Strasbourg, France;
| | - Olivier Hanon
- Service de Gériatrie, APHP, Hôpital Broca, Université de Paris, 54 Rue Pascal, 75013 Paris, France;
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Zulfiqar AA, Courtois T, Doucet J, Andres E. [Prescribing inappropriate medication in the elderly: review of the main therapeutic scales]. SOINS. GERONTOLOGIE 2021; 26:40-43. [PMID: 33894914 DOI: 10.1016/j.sger.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Abrar-Ahmad Zulfiqar
- Département de médecine interne, hôpital civil, centre hospitalier régional universitaire de Strasbourg, 1 place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
| | - Thibault Courtois
- Département de médecine générale, centre hospitalier universitaire de Rouen, 37 boulevard Gambetta, 76000 Rouen, France
| | - Jean Doucet
- Département de médecine interne polyvalente, hôpital Saint-Julien, centre hospitalier universitaire Rouen, 2 rue Guillaume-Lecointe, 76140 Le Petit-Quevilly, France
| | - Emmanuel Andres
- Département de médecine interne, hôpital civil, centre hospitalier régional universitaire de Strasbourg, 1 place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
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Drug interactions for elderly people with mental and behavioral disorders: a systematic scoping review. Arch Gerontol Geriatr 2020; 93:104283. [PMID: 33227533 DOI: 10.1016/j.archger.2020.104283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/08/2020] [Accepted: 10/09/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To identify drug interactions of potentially inappropriate medications and mental and behavioral disorders, according to explicit potentially inappropriate medications criteria-based tools. METHODOLOGY A systematic scoping review was conducted in February 2020. Study characteristics, potentially inappropriate medications, drug interactions, rationale, and therapeutic management proposed were extracted. The commercialization and potentially inappropriate medications standard as essential in Brazil and in the world were identified. Therapeutic management was proposed for the most cited potentially inappropriate medications. RESULTS 36 tools including 151 drug interactions, in addition to 132 potentially inappropriate medications with concerns related to six mental and behavioral disorders were identified. Cognitive impairment and dementia were the most frequently disorders reported and antipsychotics, anticholinergics, and benzodiazepines were the pharmacological classes more involved in the drug interactions. Despite the tools recommended risperidone and quetiapine when the use of antipsychotics were inevitable; levodopa + carbidopa for Parkinson's disease; and short and intermediate half-life benzodiazepines; the quality of the evidence needs to be assessed. In this review, sleep hygiene; deprescription; medication review; and clinical monitoring of adverse drug reactions are strongly recommended. In addition, to consider agomelatine, bupropion, moclobemide and melatonin as potential safer options for benzodiazepines. CONCLUSION Knowing the clinical conditions or risk morbidities associated with the use of potentially inappropriate medications and management of these medications for safer therapeutic equivalents or non-pharmacotherapeutic alternatives are relevant for patient safety.
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Zacarin A, Strumia M, Piau A, Bagheri H. Les médicaments potentiellement inappropriés : adaptation de la liste EU(7)PIM à la pratique médicale française. Therapie 2020; 75:663-673. [DOI: 10.1016/j.therap.2020.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 03/19/2020] [Accepted: 06/02/2020] [Indexed: 12/20/2022]
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Choukroun C, Leguelinel-Blache G, Roux-Marson C, Jamet C, Martin-Allier A, Kinowski JM, Le Guillou C, Richard H, Antoine V. Impact of a pharmacist and geriatrician medication review on drug-related problems in older outpatients with cancer. J Geriatr Oncol 2020; 12:57-63. [PMID: 32800700 DOI: 10.1016/j.jgo.2020.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/26/2020] [Accepted: 07/18/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Older patients with cancer have increased risk for comorbidity, polypharmacy (PP) and drug related problems (DRP). The aim of this study was to assess the effect of a clinical pharmacist and geriatrician medication review (MR) among older outpatients with cancer to optimize management of comorbidities during comprehensive geriatric assessment (CGA). MATERIAL AND METHODS We conducted a single-center prospective study among older outpatients with cancer (≥75 years). A pharmacist consultation was added into CGA process. The clinical pharmacist detected and assessed PP and DRP such as potentially inappropriate medications (PIM) according to the Laroche French list and STOPP criteria, START criteria and adverse drug events (ADE) risk. After a multidisciplinary MR, the proposals for prescription modification were sent to general practitioners (GPs). RESULTS Fifty-one consenting patients were recruited between May 2016 and March 2017, with a median age of 83 years. Prevalence of PP was 80.4%. 165 DRP were detected among 86% patients (median number of DRP = 3.0): 19.4% were misuse, 43.6% underuse, and 37.0% overuse. A significant decrease was observed in prevalence of PIM use (Laroche: 31.4% versus 5.9%, p = 0.002), START criteria (66.7% to 5.9%; P < 0.001) and ADE score (4.0 before MR versus 2.0 after, p = 0.023). A trend was observed for a lower number of medications (10.0 versus 8.0, p = 0.092) and on STOPP criteria prevalence (56.9% versus 31.4%, p = 0.12). CONCLUSION A clinical pharmacist and a geriatrician MR is effective to detect and reduce DRP in older outpatients with cancer.
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Affiliation(s)
- Chloé Choukroun
- Department of Pharmacy, CHU Nimes, Univ Montpellier, Nimes, France.
| | - Géraldine Leguelinel-Blache
- Department of Pharmacy, CHU Nimes, Univ Montpellier, Nimes, France; UPRES EA2415, Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, Clinical Research University Institute, Univ Montpellier, Montpellier, France; Department of Law and Health Economics, Univ Montpellier, Montpellier, France
| | | | - Charlotte Jamet
- Department of Pharmacy, CHU Nimes, Univ Montpellier, Nimes, France
| | - Amy Martin-Allier
- Department of Geriatric Medicine, CHU Nimes, Univ Montpellier, Nimes, France
| | - Jean-Marie Kinowski
- Department of Pharmacy, CHU Nimes, Univ Montpellier, Nimes, France; UPRES EA2415, Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, Clinical Research University Institute, Univ Montpellier, Montpellier, France
| | - Cédric Le Guillou
- Department of Geriatric Medicine, CHU Nimes, Univ Montpellier, Nimes, France
| | - Hélène Richard
- Department of Pharmacy, CHU Nimes, Univ Montpellier, Nimes, France
| | - Valéry Antoine
- Department of Geriatric Medicine, CHU Nimes, Univ Montpellier, Nimes, France
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Qassemi S, Pagès A, Rouch L, Bismuth S, Stillmunkes A, Lapeyre-Mestre M, McCambridge C, Cool C, Cestac P. Potentially Inappropriate Drug Prescribing in French Nursing Home Residents: An Observational Study. PHARMACY 2020; 8:E133. [PMID: 32751644 PMCID: PMC7559159 DOI: 10.3390/pharmacy8030133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/16/2020] [Accepted: 07/26/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose: To identify the prevalence of potentially inappropriate drug prescription in a sample of nursing home residents in France, combining explicit criteria and implicit approach and to involve pharmacists in the multi-professional process of therapeutic optimization. Methods: A cross-sectional, observational, multicenter study was conducted during a five-month period in a sample of French nursing homes. Information on drug prescription, diseases, and socio-demographic characteristics of nursing home residents was collected. For each prescription, identification of potentially inappropriate drug prescription was done, based on explicit and implicit criteria. Results: Nursing home residents were administered an average of 8.1 (SD 3.2, range 0-20) drugs per day. Nearly 87% (n = 237) of the residents had polypharmacy with five or more drugs prescribed per day. Among the 274 nursing home residents recruited from five nursing homes, 212 (77.4%) had at least one potentially inappropriate drug prescription. According to the Laroche list, 84 residents (30.7%) had at least one drug with an unfavorable benefit-harm balance. An overdosing was found for 20.1% (n = 55) of the residents. Nearly 30% (n = 82) of the residents had a drug prescribed without valid medical indication. Conclusions: This study shows that potentially inappropriate drug prescriptions are highly prevalent among nursing home residents, nevertheless pharmacists can take part in drug utilization review in collaboration with the nursing home staff.
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Affiliation(s)
- Soraya Qassemi
- Department of Pharmacy, Toulouse University Hospital, 31000 Toulouse, France; (S.Q.); (C.M.); (C.C.); (P.C.)
| | - Arnaud Pagès
- Department of Pharmacy, Institute of Aging, Toulouse University Hospital, 31000 Toulouse, France;
| | - Laure Rouch
- Department of Pharmacy, Institute of Aging, Toulouse University Hospital, 31000 Toulouse, France;
| | - Serge Bismuth
- Department of Primary Care, University of Toulouse, 31000 Toulouse, France; (S.B.); (A.S.)
| | - André Stillmunkes
- Department of Primary Care, University of Toulouse, 31000 Toulouse, France; (S.B.); (A.S.)
| | - Maryse Lapeyre-Mestre
- Department of Clinical Pharmacology, Toulouse University Hospital, 31000 Toulouse, France;
| | - Cécile McCambridge
- Department of Pharmacy, Toulouse University Hospital, 31000 Toulouse, France; (S.Q.); (C.M.); (C.C.); (P.C.)
| | - Charlène Cool
- Department of Pharmacy, Toulouse University Hospital, 31000 Toulouse, France; (S.Q.); (C.M.); (C.C.); (P.C.)
| | - Philippe Cestac
- Department of Pharmacy, Toulouse University Hospital, 31000 Toulouse, France; (S.Q.); (C.M.); (C.C.); (P.C.)
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Roux-Marson C, Baranski JB, Fafin C, Exterman G, Vigneau C, Couchoud C, Moranne O, Investigators PSPA. Medication burden and inappropriate prescription risk among elderly with advanced chronic kidney disease. BMC Geriatr 2020; 20:87. [PMID: 32131742 PMCID: PMC7057617 DOI: 10.1186/s12877-020-1485-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 02/20/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Elderly patients with chronic kidney disease (CKD) frequently present comorbidities that put them at risk of polypharmacy and medication-related problems. This study aims to describe the overall medication profile of patients aged ≥75 years with advanced CKD from a multicenter French study and specifically the renally (RIMs) and potentially inappropriate-for-the-elderly medications (PIMs) that they take. METHODS This is a cross-sectional analysis of medication profiles of individuals aged ≥75 years with eGFR < 20 ml/min/1.73 m2 followed by a nephrologist, who collected their active prescriptions at the study inclusion visit. Medication profiles were first analyzed according to route of administration, therapeutic classification. Second, patients were classified according to their risk of potential medication-related problems, based on whether the prescription was a RIM or a PIM. RIMs and PIMs have been defined according to renal appropriateness guidelines and to Beer's criteria in the elderly. RIMs were subclassified by 4 types of category: (a) contraindication; (b) dose modification is recommended based on creatinine clearance (CrCl); (c) dose modification based on CrCl is not recommended but a maximum daily dose is mentioned, (d) no specific recommendations based on CrCl: "use with caution", "avoid in severe impairment", "careful monitoring of dose is required" "reduce the dose". RESULTS We collected 5196 individual medication prescriptions for 556 patients, for a median of 9 daily medications [7-11]. Antihypertensive agents, antithrombotics, and antianemics were the classes most frequently prescribed. Moreover, 77.0% of patients had at least 1 medication classified as a RIM. They accounted 31.3% of the drugs prescribed and 9.25% was contraindicated drugs. At least 1 PIM was taken by 57.6 and 45.5% of patients had at least one medication classified as RIM and PIM. The prescriptions most frequently requiring reassessment due to potential adverse effects were for proton pump inhibitors and allopurinol. The PIMs for which deprescription is especially important in this population are rilmenidine, long-term benzodiazepines, and anticholinergic drugs such as hydroxyzine. CONCLUSION We showed potential drug-related problems in elderly patients with advanced CKD. Healthcare providers must reassess each medication prescribed for this population, particularly the specific medications identified here. TRIAL REGISTRATION NCT02910908.
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Affiliation(s)
- Clarisse Roux-Marson
- Department of Pharmacy, Nîmes University Hospital, Nîmes, France. .,Laboratoire Epidemiologie, Santé Publique, Biostatistiques, Université Montpellier, EA2415, Nimes, France.
| | | | - Coraline Fafin
- Department of Nephrology, Dialysis and Apheresis, Nîmes University Hospital, Nîmes, France
| | | | - Cecile Vigneau
- CHU Rennes, Department of nephrology, 3 rue H le Guilloux, 35000, Rennes, France.,INSERM U1085-IRSET, Rennes, France
| | - Cecile Couchoud
- REIN registry, Agence de la biomédecine, 1 avenue du stade de France, 93212 Saint Denis La Plaine, Saint-Denis, France.,Laboratoire Biostatistique Santé Université Claude Bernard Lyon I, UMR CNRS 5558, Lyon, France
| | - Olivier Moranne
- Laboratoire Epidemiologie, Santé Publique, Biostatistiques, Université Montpellier, EA2415, Nimes, France. .,Department of Nephrology, Dialysis and Apheresis, Nîmes University Hospital, Nîmes, France.
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Gonzalez-Colaço Harmand M, Aldea-Perona AM, Boada-Fernández del Campo C, Areosa-Sastre A, Rodríguez-Jiménez C, García Sánchez-Colomer M, Fernández Quintana E, Plasencia-Nuñez M, Masiero-Aparicio P, Grillo-Grillo C, Orellana-Mobilli A, García Sáiz M, Duarte Diéguez C, Hornillos Calvo M, Avellana Zaragoza JA, Martínez Velilla N, de Guzmán Pérez Hernández D, Ruiz González M, Blanco Reina E, Asensio Ostos C, Peiró A, Cabrera García L, Hortigüela Moro F, Pérez Alayón H, Espárrago García I, Santana Quilez J, Alonso Ramírez J, Fernández Oropesa C, López Varona MJ, Acín Gerico MT, Sanz Alvarez E, Martín de la Sierra MÁ, Peñalver MJ, Falomir Gómez T, Ruiz Salazar J, Rivas GE, Rey Rodríguez E. Spanish list of potentially inappropriate drugs in the elderly (ES-PIA project). Eur J Clin Pharmacol 2019; 75:1161-1176. [DOI: 10.1007/s00228-019-02684-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 04/15/2019] [Indexed: 12/20/2022]
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Granat C, Lacour A, Famin M. La prescription médicamenteuse chez la personne âgée. ACTUALITES PHARMACEUTIQUES 2019. [DOI: 10.1016/j.actpha.2019.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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20
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Berthe-Aucejo A, Nguyen PKH, Angoulvant F, Bellettre X, Albaret P, Weil T, Boulkedid R, Bourdon O, Prot-Labarthe S. Retrospective study of irrational prescribing in French paediatric hospital: prevalence of inappropriate prescription detected by Pediatrics: Omission of Prescription and Inappropriate prescription (POPI) in the emergency unit and in the ambulatory setting. BMJ Open 2019; 9:e019186. [PMID: 30898791 PMCID: PMC6475152 DOI: 10.1136/bmjopen-2017-019186] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Pediatrics: Omission of Prescription and Inappropriate prescription (POPI) is the first detection tool for potentially inappropriate medicines (PIMs) and potentially prescribing omissions (PPOs) in paediatrics. The aim of this study was to evaluate the prevalence of PIM and PPO detected by POPI regarding prescriptions in hospital and for outpatients. The second objective is to determine the risk factors related to PIM and PPO. DESIGN A retrospective, descriptive study was conducted in the emergency department (ED) and community pharmacy (CP) during 6 months. POPI was used to identify PIM and PPO. SETTING Robert-Debré Hospital (France) and Albaret community pharmacy (Seine and Marne). PARTICIPANTS Patients who were under 18 years old and who had one or more drugs prescribed were included. Exclusion criteria consisted of inaccessible medical records for patients consulted in ED and prescription without drugs for outpatients. PRIMARY AND SECONDARY OUTCOME MEASURES PIM and PPO rate and risk factors. RESULTS At the ED, 18 562 prescriptions of 15 973 patients and 4780 prescriptions of 2225 patients at the CP were analysed. The PIM rate and PPO rate were, respectively, 2.9% and 2.3% at the ED and 12.3% and 6.1% at the CP. Respiratory and digestive diseases had the highest rate of PIM. CONCLUSION This is the first study to assess the prevalence of PIM and PPO detected by POPI in a paediatric population. This study assessed PIMs or PPOs within a hospital and a community pharmacy. POPI could be used to improve drug use and patient care and to limit hospitalisation and adverse drug reaction. A prospective multicentric study should be conducted to evaluate the impact and benefit of implementing POPI in clinical practice.
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Affiliation(s)
- Aurore Berthe-Aucejo
- Department of Pharmacy, AP-HP, Robert-Debré Hospital, Paris, France
- UMR-S1123, ECEVE; Inserm U1123, INSERM, Paris, Île-de-France, France
| | | | - François Angoulvant
- UMR-S1123, ECEVE; Inserm U1123, INSERM, Paris, Île-de-France, France
- Emergency Unit, AP-HP, Necker Hospital, Paris, Île-de-France, France
| | - Xavier Bellettre
- Emergency unit, AP-HP, Robert-Debré Hospital, Paris, Île-de-France, France
| | - Patrick Albaret
- Pharmacy, Albaret Pharmacy, Cesson, France
- Clinical Pharmacy, Paris Descartes University, Paris, Île-de-France, France
| | - Thomas Weil
- Department of Pharmacy, AP-HP, Robert-Debré Hospital, Paris, France
| | - Rym Boulkedid
- UMR-S1123, ECEVE; Inserm U1123, INSERM, Paris, Île-de-France, France
- Clinical Epidemiology Unit, Robert-Debré Hospital, Paris, Île-de-France, France
- CIC-EC 1426, AP-HP, Robert-Debré Hospital, Paris, Île-de-France, France
| | - Olivier Bourdon
- Department of Pharmacy, AP-HP, Robert-Debré Hospital, Paris, France
- Clinical Pharmacy, Paris Descartes University, Paris, Île-de-France, France
- Laboratoire Educations et Pratiques de Santé, Paris XIII University, Bobigny, France
- Groupe Pédiatrie, Société Française de Pharmacie Clinique, Paris, France
| | - Sonia Prot-Labarthe
- Department of Pharmacy, AP-HP, Robert-Debré Hospital, Paris, France
- UMR-S1123, ECEVE; Inserm U1123, INSERM, Paris, Île-de-France, France
- Groupe Pédiatrie, Société Française de Pharmacie Clinique, Paris, France
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Buttard M, Putot A, d'Athis P, Pioro L, Asgassou S, Putot S, Deïdda M, Laborde C, Dipanda M, Mahmoudi R, Manckoundia P. [Evaluation of the prescription of furosemide in persons aged 75years and older in a geriatric acute-care unit]. Ann Cardiol Angeiol (Paris) 2018; 67:238-243. [PMID: 29759801 DOI: 10.1016/j.ancard.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 04/24/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Furosemide is very often prescribed in France. It may cause important adverse effects especially in elderly persons. In order to limit its misuse and excessive expenditure for health insurance organizations, the European Society of Cardiology drafted strict guidelines for its prescription. We conducted a study in this population to determine the rate of prescription of furosemide in elderly persons outside the guidelines. METHOD This was a prospective, single-centre, observational study bearing on elderly persons aged 75years and more admitted to a geriatric acute-care unit over a period of 6months. The prevalence of furosemide prescription and the proportion of prescriptions outside guidelines were calculated. The sociodemographic and medical characteristics of patients treated with furosemide were studied as were the modalities of furosemide prescription. RESULTS In the 818 patients hospitalized during the period of the study, 267 were taking furosemide at admission (32.6%). Among these prescriptions, 69.2% were outside the guidelines. Arterial hypertension was the leading indication for furosemide (38.2%), followed by chronic heart failure (24.3%). CONCLUSION This study confirmed the high prevalence of furosemide prescription and its misuse. Furosemide is often re-prescribed with no medical re-evaluation.
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Affiliation(s)
- M Buttard
- Pôle personnes âgées, hôpital de Champmaillot, CHU, BP 87 909, 2, rue Jules-Violle, 21079 Dijon cedex, France
| | - A Putot
- Pôle personnes âgées, hôpital de Champmaillot, CHU, BP 87 909, 2, rue Jules-Violle, 21079 Dijon cedex, France
| | - P d'Athis
- Département d'information médicale, hôpital François-Mitterrand, CHU, BP 87 909, 2, rue Maréchal-de-Lattre-de-Tassigny, 21079 Dijon cedex, France
| | - L Pioro
- Pôle personnes âgées, hôpital de Champmaillot, CHU, BP 87 909, 2, rue Jules-Violle, 21079 Dijon cedex, France
| | - S Asgassou
- Pôle personnes âgées, hôpital de Champmaillot, CHU, BP 87 909, 2, rue Jules-Violle, 21079 Dijon cedex, France
| | - S Putot
- Pôle personnes âgées, hôpital de Champmaillot, CHU, BP 87 909, 2, rue Jules-Violle, 21079 Dijon cedex, France
| | - M Deïdda
- Pôle personnes âgées, hôpital de Champmaillot, CHU, BP 87 909, 2, rue Jules-Violle, 21079 Dijon cedex, France
| | - C Laborde
- Pôle personnes âgées, hôpital de Champmaillot, CHU, BP 87 909, 2, rue Jules-Violle, 21079 Dijon cedex, France
| | - M Dipanda
- Pôle personnes âgées, hôpital de Champmaillot, CHU, BP 87 909, 2, rue Jules-Violle, 21079 Dijon cedex, France
| | - R Mahmoudi
- Service de médecine interne et gériatrie, hôpital Maison-Blanche, CHU, 51092 Reims, France
| | - P Manckoundia
- Pôle personnes âgées, hôpital de Champmaillot, CHU, BP 87 909, 2, rue Jules-Violle, 21079 Dijon cedex, France; UMR Inserm/U1093 cognition, action, plasticité sensorimotrice, université de Bourgogne Franche-Comté, 21078 Dijon cedex, France.
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Schwab C, Korb-Savoldelli V, Escudie JB, Fernandez C, Durieux P, Saint-Jean O, Sabatier B. Iatrogenic risk factors associated with hospital readmission of elderly patients: A matched case-control study using a clinical data warehouse. J Clin Pharm Ther 2018; 43:393-400. [PMID: 29446115 DOI: 10.1111/jcpt.12670] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/09/2018] [Indexed: 12/29/2022]
Abstract
WHAT IS KNOWN Hospital readmission within 30 days of patient discharge has become a standard to judge the quality of hospitalizations. It is estimated that 14% of the elderly, people over 75 years old or those over 65 with comorbidities, are at risk of readmission, of which 23% are avoidable. It may be possible to identify elderly patients at risk of readmission and implement steps to reduce avoidable readmissions. OBJECTIVE The aim of this study was to identify iatrogenic risk factors for readmission. The secondary objective was to evaluate the rate of drug-related readmissions (DRRs) among all readmissions and compare it to the rate of readmissions for other reasons. METHODS We conducted a retrospective, matched, case-control study to identify non-demographic risk factors for avoidable readmission, specifically DRRs. The study included patients hospitalized between 1 September 2014 and 31 October 2015 in an 800-bed university hospital. We included patients aged 75 and over. Cases consisted of patients readmitted to the emergency department within 30 days of initial discharge. Controls did not return to the emergency department within 30 days. Cases and controls were matched on sex and age because they are known as readmissions risk factors. After comparison of the mean or percentage between cases and controls for each variable, we conducted a conditional logistic regression. RESULTS The risk factors identified were an emergency admission at the index hospitalization, returning home after discharge, a history of unplanned readmissions and prescription of nervous system drugs. Otherwise, 11.4% of the readmissions were DRRs, of which 30% were caused by an overdose of antihypertensive. The number of drugs at readmission was higher, and potentially inappropriate medications were more widely prescribed for DRRs than for readmissions for other reasons. WHAT IS NEW AND CONCLUSION In this matched case-control retrospective study, after controlling for gender and age, we identified the typical profile of elderly patients at risk of readmission. These patients had an unplanned admission at the index hospitalization and prescribed nervous system drugs at discharge from the index admission; they have a history of unplanned readmission within 30 days and return home after discharge.
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Affiliation(s)
- C Schwab
- INSERM UMR 1138, Equipe 22, Centre de Recherche des Cordeliers, Universités Paris, Paris, France.,Service Pharmacie, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - V Korb-Savoldelli
- Service Pharmacie, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France.,Université Paris-Sud, Faculté de Pharmacie, Châtenay-Malabry, France
| | - J B Escudie
- INSERM UMR 1138, Equipe 22, Centre de Recherche des Cordeliers, Universités Paris, Paris, France.,Département de Santé Publique et Informatique Médicale, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - C Fernandez
- Université Paris-Sud, Faculté de Pharmacie, Châtenay-Malabry, France.,Service de Pharmacie, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR-S 1136, Institut Pierre Louis D'Epidémiologie et de Santé Publique, Paris, France
| | - P Durieux
- INSERM UMR 1138, Equipe 22, Centre de Recherche des Cordeliers, Universités Paris, Paris, France.,Département de Santé Publique et Informatique Médicale, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - O Saint-Jean
- Faculté de Médecine, Université Paris-Descartes, Paris, France.,Service de Gériatrie, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - B Sabatier
- INSERM UMR 1138, Equipe 22, Centre de Recherche des Cordeliers, Universités Paris, Paris, France.,Service Pharmacie, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
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Vogel T, Lang PO. Iatrogénie chez la personne âgée. ACTUALITES PHARMACEUTIQUES 2018. [DOI: 10.1016/j.actpha.2017.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Iatrogénie médicamenteuse chez la personne âgée, comprendre et agir. ACTUALITES PHARMACEUTIQUES 2017. [DOI: 10.1016/j.actpha.2017.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pandraud-Riguet I, Bonnet-Zamponi D, Bourcier E, Buyse M, Laribe-Caget S, Frémont P, Pautas E, Verny C, Hindlet P, Fernandez C. Monitoring of Potentially Inappropriate Prescriptions in Older Inpatients: A French Multicenter Study. J Am Geriatr Soc 2017; 65:2713-2719. [DOI: 10.1111/jgs.15081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Irène Pandraud-Riguet
- Service de Pharmacie; Hôpital Saint-Antoine; Assistance Publique - Hôpitaux de Paris; Paris France
| | - Dominique Bonnet-Zamponi
- Observatoire du Médicament des Dispositifs Médicaux et de l'Innovation Thérapeutique Ile de France; Paris France
- Centre de Pharmaco-Epidémiologie; Assistance Publique - Hôpitaux de Paris; Paris France
| | - Elsa Bourcier
- Service de Pharmacie; Hôpital Saint-Antoine; Assistance Publique - Hôpitaux de Paris; Paris France
- Sorbonne Universités; UPMC Université Paris 06; INSERM; Institut Pierre Louis d'Epidémiologie et de Santé Publique; France
- Faculté de Pharmacie; Université Paris-Sud; Chatenay-Malabry France
| | - Marion Buyse
- Service de Pharmacie; Fondation Ildys; Roscoff France
| | - Sandra Laribe-Caget
- Service de Pharmacie; Hôpital Rothschild; Assistance Publique - Hôpitaux de Paris; Paris France
| | - Patrick Frémont
- Service de Psychiatrie; CH Lagny-Marne La Vallée; Lagny sur Marne France
| | - Eric Pautas
- Court Séjour Gériatrique; Hôpital Charles-Foix; Assistance Publique - Hôpitaux de Paris; Ivry-sur-Seine France
- Unité de Formation et de Recherche de Médecine Pierre-et-Marie-Curie; Université Paris 06; Paris France
| | - Christiane Verny
- Service de Gériatrie; Assistance Publique - Hôpitaux de Paris; Hôpital Bicêtre; Le Kremlin-Bicêtre France
| | - Patrick Hindlet
- Service de Pharmacie; Hôpital Saint-Antoine; Assistance Publique - Hôpitaux de Paris; Paris France
- Sorbonne Universités; UPMC Université Paris 06; INSERM; Institut Pierre Louis d'Epidémiologie et de Santé Publique; France
- Faculté de Pharmacie; Université Paris-Sud; Chatenay-Malabry France
| | - Christine Fernandez
- Service de Pharmacie; Hôpital Saint-Antoine; Assistance Publique - Hôpitaux de Paris; Paris France
- Sorbonne Universités; UPMC Université Paris 06; INSERM; Institut Pierre Louis d'Epidémiologie et de Santé Publique; France
- Faculté de Pharmacie; Université Paris-Sud; Chatenay-Malabry France
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Quality of prescribing in community-dwelling elderly patients in France: an observational study in community pharmacies. Int J Clin Pharm 2017; 39:1220-1227. [PMID: 28905162 DOI: 10.1007/s11096-017-0531-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 09/05/2017] [Indexed: 12/28/2022]
Abstract
Background In order to ensure safer prescriptions in the elderly, lists of potentially inappropriate medications (PIMs) and guidelines have been introduced. Whereas the effectiveness of these measures has been well studied in hospitals, data are sparse for the community-dwelling patients. Objective To assess the quality of prescriptions among community-dwelling elderly patients, and potential associations between prescription patterns, patient characteristics and medication adherence. Setting Community pharmacies in France. Method We conducted a prospective observational study between January and June 2013. Patients aged 75 and over coming to the community pharmacy with a prescription from a general practitioner were invited to participate to the study. The compliance of the prescription was assessed with regards to Beers Criteria and French Health Authority guidelines (FHA) for prescription in the elderly, the degree of adherence was assessed with the Girerd score. Main outcome measure Percentage of prescriptions compliant with Beers Criteria and FHA guidelines. Results Among the 1206 prescriptions analysed, 67.49% (n = 814) contained a PIM. Only 12.77% (n = 154) complied with mandatory requirements of the FHA. Prescriptions were ordered by therapeutic field in 51.24% (n = 618) of cases. Dosing regimen was incomplete in 57.21% (n = 690) of prescriptions. Only 29.19% (n = 352) of patients reported no difficulty with regard to adherence (Girerd score = 0). The use of International Non-proprietary Name was associated with an increased risk of nonadherence (adjusted OR = 1.59 [95% CI = 1.13-2.23] and 1.68 [95% CI = 1.12-2.49] respectively). Patient satisfaction with formulation was associated with a lower risk of non-adherence (adjusted OR = 0.63 [95% CI = 0.45-0.90]). Conclusion A substantial proportion of patients are exposed to PIMs and prescriptions that do not comply with the FHA Guidelines. This issue, as well as identified risk factors for non-adherence, should be taken into consideration by general practitioners and community pharmacists when prescribing/dispensing medications to the elderly.
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Hannou S, Voirol P, Pannatier A, Weibel ML, Sadeghipour F, von Gunten A, Mall JF, De Giorgi Salamun I. Pharmacist intervention acceptance for the reduction of potentially inappropriate drug prescribing in acute psychiatry. Int J Clin Pharm 2017; 39:1228-1236. [PMID: 28905171 DOI: 10.1007/s11096-017-0513-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 07/19/2017] [Indexed: 12/28/2022]
Abstract
Background Prescribing for the elderly is challenging. A previous observational study conducted in our geriatric psychiatry admission unit (GPAU) using STOPP/START criteria showed a high number of potentially inappropriate drug prescriptions (PIDPs). A clinical pharmacist was added to our GPAU as a strategy to reduce PIDPs. Objective The objective of the present study was to assess the impact of a clinical pharmacist on PIDPs by measuring acceptance rates of pharmacist interventions (PhIs). Setting This study was conducted at the GPAU of Lausanne University Hospital. Method The clinical pharmacist attended four GPAU meetings weekly. Complete medication reviews were performed daily. The clinical pharmacist conducted standard analyses based on clinical judgment and STOPP/START criteria assessment. A PhI was generated when a PIDP was detected. When a PhI was accepted, the PIDP was considered as eliminated. Acceptance rate of PhI was calculated (number of PhI accepted/total number of PhI). Main outcome measure PhIs acceptance rates. Results In a cohort of 102 patients seen between July 2013 and February 2014, a total of 697 PhIs (average 6.8/patient) were made based on standard evaluation (n = 479) and STOPP/START criteria (n = 243). The global acceptance rate was 68% (standard, 78%; STOPP/START, 47%). Conclusion Good PhIs acceptance rates demonstrated that a clinical pharmacist can reduce PIDPs in a GPAU. PhIs based on standard evaluation had a higher acceptance than those based on STOPP/START criteria, probably because they are better adapted to individual patients. However, these two evaluation approaches can be used in a complementary manner.
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Affiliation(s)
- Sophia Hannou
- Pharmacy, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre Voirol
- Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.,School of Pharmaceutical Sciences, Geneva and Lausanne University, Lausanne, Switzerland
| | - André Pannatier
- Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.,School of Pharmaceutical Sciences, Geneva and Lausanne University, Lausanne, Switzerland
| | | | - Farshid Sadeghipour
- Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.,School of Pharmaceutical Sciences, Geneva and Lausanne University, Lausanne, Switzerland
| | - Armin von Gunten
- Geriatric Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Frédéric Mall
- Geriatric Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
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Hamzaoui A, Joulié A, El Dachri Y. [Polypharmacy and geriatric psychiatry]. SOINS. GERONTOLOGIE 2017; 22:17-21. [PMID: 28917331 DOI: 10.1016/j.sger.2017.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The ageing of the population is synonymous with multiple pathologies and polypharmacy, which increases risk factors. François-Tosquelles general hospital carried out a study into the administering of medicines within the ageing population in psychiatry and drew up an assessment of professional practices with regard to polypharmacy in geriatric psychiatry.
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Affiliation(s)
- Abdelkrim Hamzaoui
- Centre hospitalier François-Tosquelles, rue de l'hôpital, 48120 Saint-Alban, France.
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Menecier P, Menecier-Ossia L. [Medicines and elderly patients: abuse, dependency or attraction?]. SOINS. GERONTOLOGIE 2017; 22:16-20. [PMID: 28224957 DOI: 10.1016/j.sger.2016.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Psychotropic medicines represent, after alcohol, the second class of substances most susceptible to abuse by elderly people. It can be particularly difficult for caregivers to understand such behaviour as these are prescription-only medicines. This misuse is partly a result of older people tending to trivialise and overrate pharmaceutical drugs, ignoring the potential of non-medicinal methods and psychotherapeutic treatments. The boundaries between prescribed use, overuse, self-medication, excessive use, dependency or addiction to prescription drugs are blurred in older people. Alongside withdrawal methods, prevention must be prioritised by respecting the recommendations of medicine prescriptions in geriatrics and deprescription.
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Affiliation(s)
- Pascal Menecier
- Centre Hospitalier de Mâcon, boulevard Louis-Escande, 71018 Mâcon cedex, France; Institut de psychologie, Université Lyon 2, 5 avenue Pierre-Mendès-France, Campus Porte des Alpes, 69500 Bron, France.
| | - Laure Menecier-Ossia
- Service de court séjour et SSR, Centre hospitalier Michel-Poisat, Chemin des Nivres, 01190 Pont de Vaux, France
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PHARMAID study protocol: Randomized controlled trial to assess the impact of integrated pharmaceutical care at a psychosocial intervention on caregiver's burden in Alzheimer's disease or related diseases. Contemp Clin Trials 2016; 53:137-142. [PMID: 28007635 DOI: 10.1016/j.cct.2016.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/13/2016] [Accepted: 12/18/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Alzheimer's Disease and Related Diseases (ADRD) are associated with a caregiver burden that increases with the progression of the disease. Psychosocial interventions reported a moderate improvement on caregivers' burden. Patients with ADRD and their older caregivers are also exposed to a higher risk of developing drug-related problems. The main objective of the PHARMAID study is to measure the impact of personalized pharmaceutical collaborative care integrated to a multidisciplinary psychosocial program on the burden of caregivers. METHODS The PHARMAID study is a 18-month randomized controlled trial that started in September 2016. This paper describes the study protocol. PHARMAID plans to enroll 240 dyads, i.e. ADRD patients and caregivers, whose inclusion criteria are: outpatient with mild or major neurocognitive disorders due to ADRD, living at home, receiving support from a family caregiver. Three parallel groups will compare a control group with two experimental groups: psychosocial intervention and integrated pharmaceutical care at a psychosocial intervention. The main outcome is the caregiver's burden assessed by the Zarit Burden Index at 6, 12 and 18months. DISCUSSION This is the first trial designed to assess the specific impact of the integration of pharmaceutical care in a multidisciplinary psychosocial program on the caregiver's burden. The results will inform policymakers on strategies to implement in the near future. TRIAL REGISTRATION NUMBER [ClinicalTrials.gov: NCT02802371] Registered in June 2016.
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Humaraut C, Caron J, Bayonne L, Moalic Y. Audit clinique ciblé sur la prise en charge médicamenteuse chez le sujet âgé hospitalisé en psychiatrie. Encephale 2016; 42:14-23. [DOI: 10.1016/j.encep.2015.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 05/05/2014] [Indexed: 11/26/2022]
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Blain H, Rambourg P, Le Quellec A, Ayach L, Biboulet P, Bismuth M, Blain A, Boulenger J, Celton B, Combe B, Dauvilliers Y, Davy J, Geny C, Hemmi P, Hillaire-Buys D, Jalabert A, Jung B, Leclercq F, Léglise M, Morel J, Mourad G, Ponrouch M, Puisieux F, Quantin X, Quéré I, Renard E, Ribstein J, Roch-Torreilles I, Rolland Y, Rosant D, Terminet A, Thuret R, Villiet M, Deshormières N, Bourret R, Bousquet J, Jonquet O, Millat B. Bon usage des médicaments chez le sujet âgé. Rev Med Interne 2015; 36:677-89. [DOI: 10.1016/j.revmed.2015.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 03/13/2015] [Indexed: 11/25/2022]
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Boyé F, Sallerin B, Ah Kang F, Arnaud A, Kantambadouno JB, Amar J, Chamontin B, Bouhanick B. [Place of clinical pharmacist in the management of drugs in patients with hypertension]. Ann Cardiol Angeiol (Paris) 2015; 64:216-21. [PMID: 26051854 DOI: 10.1016/j.ancard.2015.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 04/28/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE To synthesize pharmacists' interventions made in the department of internal medicine and hypertension of university hospital of Toulouse and assess the impact on medication orders. METHODS This is a single-center, prospective study using pharmacists' interventions recorded between September 2013 and March 2014 on the Act-IP(©) website of the French Society of Clinical Pharmacy. The clinical pharmacist is present everyday in the unit to establish the medication reconciliation of new patients (the process of comparing a patient's medication orders to all of the medications that the patient has been taking), and analysis of medication orders. When a risk of iatrogenic drug is identified, a therapeutic change is proposed to the prescriber. RESULTS A total of 2491 medication orders were analyzed for 7 months, leading to 39 pharmacists' interventions (1.6 pharmacists' interventions per 100 medication orders). The most commonly identified drug-related problems were improper administration (33%, n=13), not prescribed drug (21%, n=8), non-conformity to guidelines (18%, n=7), supratherapeutic dose (15%, n=6), and 13% (n=5) targeted prescribed treatment not administered, underdosing, incorrect administration or drug interaction. The most relevant molecules were atorvastatin (10%), bromazepam (8%) and levothyroxine (8%) and only 2 interventions targeted antihypertensive drugs. The rate of physicians' acceptance was 92%. CONCLUSION Pharmacists' interventions mainly concern the co-prescriptions of antihypertensive drugs and very few antihypertensive drugs. The clinical pharmacist contributes to preventing iatrogenic in patients with hypertension with a very good acceptance by the clinician.
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Affiliation(s)
- F Boyé
- Pôle pharmacie, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
| | - B Sallerin
- Pôle pharmacie, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
| | - F Ah Kang
- Service de médecine interne et HTA, pôle cardiovasculaire et métabolique, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
| | - A Arnaud
- Pôle pharmacie, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
| | - J B Kantambadouno
- Service de médecine interne et HTA, pôle cardiovasculaire et métabolique, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
| | - J Amar
- Service de médecine interne et HTA, pôle cardiovasculaire et métabolique, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
| | - B Chamontin
- Service de médecine interne et HTA, pôle cardiovasculaire et métabolique, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
| | - B Bouhanick
- Service de médecine interne et HTA, pôle cardiovasculaire et métabolique, hôpital Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
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Frély A, Chazard E, Pansu A, Beuscart JB, Puisieux F. Impact of acute geriatric care in elderly patients according to the Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert doctors to Right Treatment criteria in northern France. Geriatr Gerontol Int 2015; 16:272-8. [DOI: 10.1111/ggi.12474] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2014] [Indexed: 12/26/2022]
Affiliation(s)
- Anne Frély
- Gerontology Clinic; Lens General Hospital; Lens France
| | - Emmanuel Chazard
- Department of Medical Information and Archives; CHRU Lille; Lille France
| | | | | | - François Puisieux
- Gerontology Clinic; Les Bateliers General Hospital, CHRU de Lille; Lille France
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Kanagaratnam L, Dramé M, Trenque T, Novella JL, Joachim C, Nazeyrollas P, Lang PO, Jolly D, Mahmoudi R. Effets indésirables médicamenteux chez des sujets âgés hospitalisés dans une unité spécialisée dans la prise en charge des patients atteints de syndrome démentiel. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.npg.2014.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bonin-Guillaume S, Martin G, Zafack J, Gentile G, Allaria-Lapierre V, Sciortino V, Thirion X, Micallef J. Consommation d’antipsychotiques chez les sujets atteints de maladie d’Alzheimer et maladies apparentées de la cohorte PACA-Alz 2010. Therapie 2014; 69:213-22. [DOI: 10.2515/therapie/2014015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 12/23/2013] [Indexed: 11/20/2022]
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38
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Narbey D, Jolly D, Mahmoudi R, Trenque T, Blanchard F, Novella JL, Dramé M. Relationship between anticholinergic drug use and one-year outcome among elderly people hospitalised in medical wards via emergency department: the SAFES cohort study. J Nutr Health Aging 2013; 17:766-71. [PMID: 24154649 DOI: 10.1007/s12603-013-0349-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM To investigate the relationship between anticholinergic drug use and one-year outcome of elderly patients hospitalised via the emergency department. METHODS Prospective, multicentre, cohort study of patients aged 75 years and older. Comprehensive geriatric evaluation was performed. We included in this analysis all patients for whom data on drug use was available. Anticholinergic drugs were coded using the online database "Thesorimed". One-year mortality and nursing home admission were analysed using a Cox model, with matching on the propensity to use anticholinergic drugs. RESULTS In total, 1176 subjects were included in this analysis, average age 85±6 years, 65% women. Overall, 144 (12%) were taking at least one anticholinergic drug. Mortality and nursing home admission at one year were respectively 29% and 30% in the anticholinergic group, and 34% and 33% respectively in subjects not taking anticholinergic drugs. No significant relationship was observed between anticholinergic drug use and the main endpoints. CONCLUSION Although we did not observed any statistically significant relationship between use of anticholinergic drugs and one-year outcome in elderly patients, the long-term use of anticholinergic drugs can have deleterious effects on memory and functional capacity, and therefore requires prescriptions to be reviewed regularly.
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Affiliation(s)
- D Narbey
- Moustapha Dramé, MD, MPH, PhD, Department of Geriatrics and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, 45 rue Cognacq Jay - 51092 Reims cedex, France, Telephone: + 33 3 26 78 44 12 - Fax: + 33 3 26 78 41 08, E-mail:
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Detection of potentially inappropriate medication in a French geriatric teaching hospital: A comparison study of the French Beers criteria and the improved prescribing in the elderly tool. Eur Geriatr Med 2012. [DOI: 10.1016/j.eurger.2012.07.460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lachamp M, Pauly V, Sambuc R, Thirion X, Potard I, Molines C, Retornaz F. Impact de la modification des prescriptions chez les sujets âgés hospitalisés en service de court séjour gériatrique en termes de coût. Rev Med Interne 2012; 33:482-90. [DOI: 10.1016/j.revmed.2012.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 03/20/2012] [Accepted: 05/13/2012] [Indexed: 12/16/2022]
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Gilbert T, Szczerbińska K, Ziere G, Ait S, Bonnefoy M, van der Velde N, Cruz-Jentoft A. Management of falls: France, the Netherlands, Poland. Eur Geriatr Med 2012. [DOI: 10.1016/j.eurger.2012.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jansen PAF, Brouwers JRBJ. Clinical pharmacology in old persons. SCIENTIFICA 2012; 2012:723678. [PMID: 24278735 PMCID: PMC3820465 DOI: 10.6064/2012/723678] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 06/28/2012] [Indexed: 06/02/2023]
Abstract
The epidemiological transition, with a rapid increase in the proportion in the global population aged over 65 years from 11% in 2010 to 22% in 2050 and 32% in 2100, represents a challenge for public health. More and more old persons have multimorbidities and are treated with a large number of medicines. In advanced age, the pharmacokinetics and pharmacodynamics of many drugs are altered. In addition, pharmacotherapy may be complicated by difficulties with obtaining drugs or adherence and persistence with drug regimens. Safe and effective pharmacotherapy remains one of the greatest challenges in geriatric medicine. In this paper, the main principles of geriatric pharmacology are presented.
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Affiliation(s)
- Paul A. F. Jansen
- Expertise Centre Pharmacotherapy in Old Persons, University Medical Centre Utrecht, B05.256, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Jacobus R. B. J. Brouwers
- Expertise Centre Pharmacotherapy in Old Persons, University Medical Centre Utrecht, B05.256, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
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[Potentially inappropriate prescriptions for the elderly: a study of health insurance reimbursements in Southeastern France]. Rev Epidemiol Sante Publique 2012; 60:121-30. [PMID: 22418446 DOI: 10.1016/j.respe.2011.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 09/08/2011] [Accepted: 10/03/2011] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND This study conducted in the region of Provence-Alpes-Côte d'Azur (PACA) sought to assess the feasibility of constructing and using indicators of potentially inappropriate prescriptions for the elderly from health insurance reimbursement data. We present and discuss different indicators of inappropriate prescriptions for people aged 70 years or older (at-risk prescriptions, dangerous or at-risk coprescriptions, absence of necessary coprescriptions) and reports their prevalence in PACA. METHODS The indicators were constructed from the French list of inappropriate prescriptions, national agency guidelines, and the advice of experts in the field. The indicators selected were applied to the databases of the PACA Salaried Workers' Health Insurance Fund for 2008 for all recipients aged 70 years or older and compared according to age, sex, chronic disease status, and, after standardization for age and sex, according to district of residence. RESULTS In January 2009, 500,904 recipients aged 70 years or older were identified in the data base of the Salaried Workers' Health Insurance Fund, 60.8% of whom were women and 52.1% of whom had approved coverage for a chronic disease. The potentially inappropriate prescriptions most frequently observed here, in decreasing order, were: prescription of an NSAID without the coprescription of gastric protection (28.1%); long-term benzodiazepine treatment (21.5%); prescription of long half-life benzodiazepine (14.9%), and long-term treatment with NSAIDs (11.6%). Overall, the prevalence of each increased significantly with age and was higher among women and people with chronic diseases. Significant variations were also observed between the different districts of PACA. CONCLUSION Our results confirm that a substantial proportion of elderly people receive potentially inappropriate prescriptions. They also suggest that health insurance reimbursement data could be used in some prescription domains for monitoring trends in the potentially inappropriate prescriptions in the populations of various territories, provided that specific limitations are considered.
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Uhart M, Odouard E, Carlier C, Maire P, Ducher M, Bourguignon L. [Relationship between benzodiazepines use and falls in the elderly: a multicenter study in three geriatric centers of a university hospital]. ANNALES PHARMACEUTIQUES FRANÇAISES 2012; 70:46-52. [PMID: 22341008 DOI: 10.1016/j.pharma.2011.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 09/12/2011] [Accepted: 10/10/2011] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Benzodiazepines are widely used in the elderly, but may induce potentially severe iatrogenic events like falls. The analysis of their use is difficult because of the numerous molecules and dosages available. The aim of the present study is to build a tool to monitor their consumption and to evaluate the relation between this consumption and patient's falls reported in three geriatric institutions. METHODS Conversion coefficients found in the literature allowed the expression of benzodiazepine action with a unique comparator: diazepam. Benzodiazepine consumption observed during 20 consecutive months was collected and weighted by hospital activity. A correlation between benzodiazepine consumption and the number of falls reported during the same period was researched. RESULTS Benzodiazepine consumption expressed in milligrams of diazepam-equivalent per hospitalization day is significantly linked to the number of falls expressed during the same period (R=0.63; p<0.01). However, no statistical bound was found between monthly falls variations and monthly benzodiazepine consumption variations. These results corroborate others published studies: benzodiazepine consumptions are statistically linked to falls, but the reduction of this consumption is of poor predictive value, maybe because of the multifactorial nature of falls. DISCUSSION AND CONCLUSION The expression of benzodiazepine consumption in diazepam-equivalent enables one to estimate the general exposition of patients and to compare the use of each molecule. The statistical link between this indicator and a major iatrogenic event like falls makes it a tool worth interest for both clinicians and pharmacists.
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Affiliation(s)
- M Uhart
- Service pharmaceutique, hôpital Antoine-Charial, hospices civils de Lyon, groupement hospitalier de gériatrie, Francheville, France
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Andro M, Estivin S, Gentric A. [Medicinal prescriptions in geriatrics: overuse, misuse, underuse. Qualitative analysis from the prescriptions of 200 patients admitted in an acute care geriatric unit]. Rev Med Interne 2011; 33:122-7. [PMID: 22209618 DOI: 10.1016/j.revmed.2011.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 10/12/2011] [Accepted: 11/28/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE In the elderly three modalities of suboptimal drug prescriptions are known: overuse, misuse, underuse. PATIENTS AND METHODS This prospective observational study was conducted between September 2008 and March 2009. The prescriptions of 200 patients aged over 75 years admitted in the acute care geriatric unit at the teaching hospital of Brest (France) have been qualitatively analyzed to assess the prevalence of the three types of suboptimal prescription. RESULTS A strong prevalence of overuse (77% of the patients), underuse (64.5%) and at minor degree of misuse (47.5%) were evidenced. Overuse and misuse were more frequent in polypathogical and polymedicated patients living in nursing home. Underuse was more prevalent in polypathological patients living at home. No significant relation was found between suboptimal prescriptions, age, gender or cognitive status. CONCLUSION This study demonstrates the strong prevalence of overuse, misuse and underuse prescriptions in hospitalized elderly patient and analyses the most frequently implicated drugs and the different factors predisposing to these suboptimal prescriptions. This way of analysis of prescriptions could be a pertinent method to improve drug prescription in the elderly.
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Affiliation(s)
- M Andro
- Service de médecine interne gériatrique, hôpital de la Cavale Blanche, CHRU de Brest, boulevard Tanguy-Prigent, Brest cedex, France.
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Allouetteau S, Laroche ML, Merle L, Charmes JP. Les médicaments potentiellement inappropriés en gériatrie. ACTUALITES PHARMACEUTIQUES 2011. [DOI: 10.1016/s0515-3700(11)71099-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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[STOPP-START: adaptation of a French language screening tool for detecting inappropriate prescriptions in older people]. Canadian Journal of Public Health 2010. [PMID: 20209735 DOI: 10.1007/bf03404338] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE STOPP-START is a screening tool for detecting inappropriate prescriptions in older people. Recently validated in its English-language version, it is a reliable and easy-to-use tool, allowing assessment of prescription drugs often described as inappropriate (STOPP) or unnecessarily underused (START) in this population. An adaptation of the tool into French language is presented here. METHOD A translation-back translation method, with validation of the obtained version by French-speaking experts from Belgium, Canada, France and Switzerland, has been used. An inter-rater reliability analysis completed the validation process. Fifty data sets of patients hospitalized in an academic geriatrics department (mean age +/- standard deviation: 77.6 +/- 7.9 years; 70% were women) were analyzed independently by one geriatrician and one general practitioner. RESULTS The adaptation in French considers the 87 STOPP-START criteria of the original version. They are all organized according to physiological systems. The 50 data sets involved 418 prescribed medications (median 8; inter-quartile range 5-12). The proportions of positive and negative inter-observer agreements were 99% and 95% respectively for STOPP, and 99% and 88% for START; Cohen's kappa-coefficients were 0.95 for STOPP and 0.92 for START. These results indicated an excellent inter-rater agreement. CONCLUSION Therefore, this French language version of STOPP-START is as reliable as the original English language version of the tool. For STOPP-START to have tangible clinical benefit to patients, a randomized controlled trial must be undertaken to demonstrate efficacy in the prevention of adverse clinical events connected with inappropriate prescriptions.
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