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Bouzid W, Cantet C, Berard E, Mathieu C, Hermabessière S, Houles M, Krams T, Qassemi S, Cambon A, McCambridge C, Tavassoli N, Rolland Y. Exploring Predictive Factors for Potentially Avoidable Emergency Department Transfers: Findings From the FINE Study. J Am Med Dir Assoc 2024; 25:572-579.e1. [PMID: 38159914 DOI: 10.1016/j.jamda.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES To assess the prevalence of potentially avoidable transfers (PAT) and identify factors associated with these transfers to emergency departments (EDs) among nursing home (NH) residents. DESIGN This is a secondary outcome analysis of the FINE study, a multicenter observational study collecting data on NH residents, NH settings, and contextual factors of ED transfers. SETTINGS AND PARTICIPANTS NHs in the former Midi-Pyrénées region of the southwest of France (n = 312); a total of 1037 NH residents who experienced ED transfers (n = 1017) between January 2016 and December 2016. METHODS The analysis included resident baseline characteristics and NH and transfer decision-making characteristics. An expert group categorized the transfer status as either PAT or unavoidable. Multivariable analysis using a mixed logistic model, accounting for intra-NH correlation, was conducted to assess factors independently associated with PAT. RESULTS Among 1017 included transfers, 87.02% (n = 885) were identified as PAT and 12.98% (n = 132) unavoidable transfers. Multivariable analysis revealed that the following patient-related factors were associated with a likely high rate of PAT: usual behavior disturbances before transfer, including productive trouble (OR 2.04, 95% CI 1.25-3.33; P = .0044) and unusual symptom of falling during the week preceding the transfer (OR 4.55, 95% CI 1.76-11.82; P = .0019). On the other hand, distance between ED and NH (OR 0.98, 95% CI 0.97-0.998; P = .0231), NH staff trained in palliative care in the last 3 years (OR 0.52, 95% CI 0.29-0.95; P = .0324), the impossibility of direct hospitalization to an appropriate unit (OR 0.54, 95% CI 0.34-0.87; P = .0117), and the resident Charlson Comorbidity Index (OR 0.90, 95% CI 0.82-0.99; P = .0369) were associated with a lower probability of PAT. CONCLUSION AND IMPLICATIONS Transfers from NHs to hospital EDs were frequently potentially avoidable, meaning that there are still significant opportunities to reduce PAT. Our findings may help to specifically identify interventions that should be targeted at both NH and resident levels.
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Affiliation(s)
- Wafa Bouzid
- Gérontopôle, Toulouse University Hospital, Toulouse, France; Centre Hospitalier Universitaire de Toulouse, Service d'Epidémiologie, Toulouse, France; Regional Health Agency of Occitanie, Toulouse, France.
| | | | - Emilie Berard
- Centre Hospitalier Universitaire de Toulouse, Service d'Epidémiologie, Toulouse, France; UMR 1295 CERPOP, INSERM-Université de Toulouse III, Toulouse, France
| | - Celine Mathieu
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | | | - Mathieu Houles
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - Thomas Krams
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - Soraya Qassemi
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | | | | | - Neda Tavassoli
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - Yves Rolland
- Gérontopôle, Toulouse University Hospital, Toulouse, France; Centre Hospitalier Universitaire de Toulouse, Service d'Epidémiologie, Toulouse, France
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Novais T, Qassemi S, Cestac P, McCambridge C, Villars H, Decaudin B, Dambrine M, Huvent-Grelle D, Roche J, Federico D, Krolak-Salmon P, Mouchoux C. Medication exposure of the dyad patient-caregiver in Alzheimer's disease and related dementias: a cross-sectional study. Int J Clin Pharm 2024; 46:205-209. [PMID: 37532841 DOI: 10.1007/s11096-023-01623-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Patients with Alzheimer's disease and related dementias and their caregivers can be defined as people with higher risk of developing medication-related problems due to aging and polypharmacy. AIM To assess the medication exposure of patient with Alzheimer's disease and related dementias and their caregivers. METHOD Ancillary cross-sectional study based on baseline medication data of the PHARMAID RCT. The PHARMAID study was a multi-center RCT assessing an integrated pharmaceutical care at a psychosocial program. Older outpatients with Alzheimer's disease and related dementias and their older caregivers were eligible for inclusion. Baseline medication data were used to assess the medication exposure, illustrated by the number of medications, the prevalence of potentially inappropriate medications (PIMs) using the EU(7)-PIM list and the Medication Regimen Complexity Index (MRCI). RESULTS Seventy-three dyads were included in this ancillary study. The mean numbers (SD) of medications used by patients was 6.8 (2.6) and by caregivers was 4.7 (3.7). Overall, 60.3% of patients used at least one PIM and 47.9% of caregivers. Regarding the medication regimen complexity, the mean MRCI was 16.3(8.1) for patients and 11.3(10.5) for caregivers. CONCLUSION The results of this study confirm the relevance of carrying out medication review with patients, but also with their caregivers who can be considered as hidden patients.
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Affiliation(s)
- Teddy Novais
- Pharmaceutical Unit, Department of Pharmacy, Charpennes Hospital, Hospices Civils de Lyon, University Hospital of Lyon, 69100, Villeurbanne, France.
- Lyon Institute for Aging, Hospices Civils de Lyon, 69000, Lyon, France.
- Research on Healthcare Performance (RESHAPE), INSERM U1290, University Lyon1, 69000, Lyon, France.
| | - Soraya Qassemi
- REIPO Team, La Grave Hospital, Toulouse University Hospital, 31000, Toulouse, France
| | - Philippe Cestac
- Department of Pharmacy, Toulouse University Hospital, 31000, Toulouse, France
- Centre for Epidemiology and Population Health Research (CERPOP), UMR 1027, INSERM, University of Toulouse, 31000, Toulouse, France
| | - Cécile McCambridge
- Department of Pharmacy, Toulouse University Hospital, 31000, Toulouse, France
| | - Hélène Villars
- Centre for Epidemiology and Population Health Research (CERPOP), UMR 1027, INSERM, University of Toulouse, 31000, Toulouse, France
- Geriatric Department, Toulouse University Hospital, 31000, Toulouse, France
| | - Bertrand Decaudin
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, University Lille, 59000, Lille, France
- Pharmacie Institute, CHU Lille, 59000, Lille, France
| | | | | | - Jean Roche
- Department of Geriatric Psychiatry, CHU Lille, 59000, Lille, France
| | - Denis Federico
- Lyon Institute for Aging, Hospices Civils de Lyon, 69000, Lyon, France
- Clinical and Research Memory Centre of Lyon (CMRR), Charpennes Hospital, University Hospital of Lyon, 69100, Villeurbanne, France
| | - Pierre Krolak-Salmon
- Lyon Institute for Aging, Hospices Civils de Lyon, 69000, Lyon, France
- Clinical Research Centre (CRC) - VCF (Aging - Brain - Frailty), Charpennes Hospital, University Hospital of Lyon, 69000, Villeurbanne, Lyon, France
- Neuroscience Research Centre of Lyon (CRNL), 69000, Lyon, France
| | - Christelle Mouchoux
- Pharmaceutical Unit, Department of Pharmacy, Charpennes Hospital, Hospices Civils de Lyon, University Hospital of Lyon, 69100, Villeurbanne, France
- Lyon Institute for Aging, Hospices Civils de Lyon, 69000, Lyon, France
- Clinical Research Centre (CRC) - VCF (Aging - Brain - Frailty), Charpennes Hospital, University Hospital of Lyon, 69000, Villeurbanne, Lyon, France
- Neuroscience Research Centre of Lyon (CRNL), 69000, Lyon, France
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Novais T, Qassemi S, Cestac P, McCambridge C, Villars H, Zueras A, Decaudin B, Dambrine M, Huvent-Grelle D, Roche J, Schoenenburg S, Federico D, Nier AC, Krolak-Salmon P, Mouchoux C. Impact of pharmaceutical care integrated at a psychosocial intervention to reduce caregiver's burden in Alzheimer's disease or related dementias: Negative results at 18 months and difficulties to conduct PHARMAID RCT. Contemp Clin Trials Commun 2023; 33:101146. [PMID: 37397433 PMCID: PMC10313878 DOI: 10.1016/j.conctc.2023.101146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 04/13/2023] [Accepted: 04/21/2023] [Indexed: 07/04/2023] Open
Abstract
Background Psychosocial interventions for caregivers of patients with Alzheimer disease and relative dementias (ADRD) reported a caregiver burden improvement. Multicomponent intervention integrating pharmaceutical care has not yet been evaluated while ADRD patients and their caregivers are exposed to high risk of drug-related problems. The PHARMAID study aimed to assess the impact of personalized pharmaceutical care integrated to a psychosocial program on the burden of ADRD caregivers at 18 months. Methods The PHARMAID RCT was conducted between September 2016 and June 2020 [ClinicalTrials.gov: NCT02802371]. PHARMAID study planned to enroll 240 dyads, i.e. ADRD patients and caregivers, whose inclusion criteria were: outpatient with mild or major neurocognitive disorders due to ADRD, living at home, receiving support from a family caregiver. Three parallel groups compared a control group with two interventional groups: psychosocial intervention and integrated pharmaceutical care at a psychosocial intervention. The main outcome was the caregiver burden assessed by the Zarit Burden Index (ZBI, score range 0-88) at 18 months. Results Overall, 77 dyads were included (32% of the expected sample size). At 18 months, the mean ZBI scores were 36.7 ± 16.8 in the control group, 30.3 ± 16.3 for the group with psychosocial intervention, and 28.8 ± 14.1 in group with integrated pharmaceutical care at psychosocial intervention. No significant difference was demonstrated between the three groups (p = 0.326). Conclusions The findings suggest that PHARMAID program had no significant impact on caregiver burden at 18 months. Several limitations have been highlighted and discussed by the authors in order to formulate recommendations for further research.
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Affiliation(s)
- Teddy Novais
- Department of Pharmacy, Charpennes Hospital, Hospices Civils de Lyon, F-69100, Villeurbanne, France
- Lyon Institute for Aging, Hospices Civils de Lyon, F-69000, Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, University Lyon1, F-69000, Lyon, France
| | - Soraya Qassemi
- REIPO Team, La Grave Hospital, Toulouse University Hospital, F-31000, Toulouse, France
| | - Philippe Cestac
- Department of Pharmacy, Toulouse University Hospital, F-31000, Toulouse, France
- Centre for Epidemiology and Population Health Research (CERPOP), UMR 1027, INSERM, University of Toulouse, F-31000, Toulouse, France
| | - Cécile McCambridge
- Department of Pharmacy, Toulouse University Hospital, F-31000, Toulouse, France
| | - Hélène Villars
- Centre for Epidemiology and Population Health Research (CERPOP), UMR 1027, INSERM, University of Toulouse, F-31000, Toulouse, France
- Geriatric Department, Toulouse University Hospital, F-31000, Toulouse, France
| | - Audrey Zueras
- Geriatric Department, Toulouse University Hospital, F-31000, Toulouse, France
| | - Bertrand Decaudin
- ULR 7365-GRITA-Groupe de Recherche sur Les Formes Injectables et Les Technologies Associées, University Lille, F-59000, Lille, France
- Pharmacie Institute, CHU Lille, F-59000, Lille, France
| | | | | | - Jean Roche
- Department of Geriatric Psychiatry, CHU Lille, F-59000, Lille, France
| | | | - Denis Federico
- Lyon Institute for Aging, Hospices Civils de Lyon, F-69000, Lyon, France
- Clinical and Research Memory Centre of Lyon (CMRR), Charpennes Hospital, University Hospital of Lyon, F-69100, Villeurbanne, France
| | - Anne-Cécile Nier
- Lyon Institute for Aging, Hospices Civils de Lyon, F-69000, Lyon, France
| | - Pierre Krolak-Salmon
- Lyon Institute for Aging, Hospices Civils de Lyon, F-69000, Lyon, France
- Clinical and Research Memory Centre of Lyon (CMRR), Charpennes Hospital, University Hospital of Lyon, F-69100, Villeurbanne, France
- Clinical Research Centre (CRC) - VCF (Aging – Brain - Frailty), Charpennes Hospital, University Hospital of Lyon, Villeurbanne, F-69000, Lyon, France
- Neuroscience Research Centre of Lyon (CRNL), F-69000, Lyon, France
| | - Christelle Mouchoux
- Department of Pharmacy, Charpennes Hospital, Hospices Civils de Lyon, F-69100, Villeurbanne, France
- Lyon Institute for Aging, Hospices Civils de Lyon, F-69000, Lyon, France
- Clinical Research Centre (CRC) - VCF (Aging – Brain - Frailty), Charpennes Hospital, University Hospital of Lyon, Villeurbanne, F-69000, Lyon, France
- Neuroscience Research Centre of Lyon (CRNL), F-69000, Lyon, France
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Mathieu C, McCambridge C, de Kerimel J, Jakovenko D, Lafont C. [Step 1 screening: experimentation in Occitania with nurses and pharmacists]. Soins Gerontol 2021; 26:16-19. [PMID: 34836595 DOI: 10.1016/j.sger.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Screening with the step 1 tool is the principal modality of entry into the ICOPE program. This preliminary step is particularly an initiative of primary care health professionals, who are daily caring older people. In Occitania, as part of the deployment of ICOPE program, nurses and pharmacists, were invited to integrate the step 1 in their practices. They benefited, if they wished, from a free webinar training.
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Affiliation(s)
- Céline Mathieu
- Hôpital La Grave, Cité de la santé, 1(er) étage, gérontopôle, centre hospitalier universitaire Toulouse, place Lange, 31059 Toulouse, France.
| | - Cécile McCambridge
- Hôpital La Grave, Cité de la santé, 1(er) étage, gérontopôle, centre hospitalier universitaire Toulouse, place Lange, 31059 Toulouse, France
| | - Justine de Kerimel
- Hôpital La Grave, Cité de la santé, 1(er) étage, gérontopôle, centre hospitalier universitaire Toulouse, place Lange, 31059 Toulouse, France
| | | | - Christine Lafont
- Hôpital La Grave, Cité de la santé, 1(er) étage, gérontopôle, centre hospitalier universitaire Toulouse, place Lange, 31059 Toulouse, France
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Mangé AS, Pagès A, Sourdet S, Cestac P, McCambridge C. Diabetes and Frail Older Patients: Glycemic Control and Prescription Profile in Real Life. Pharmacy (Basel) 2021; 9:pharmacy9030115. [PMID: 34206422 PMCID: PMC8293379 DOI: 10.3390/pharmacy9030115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 01/06/2023] Open
Abstract
(1) Background: The latest recommendations for diabetes management adapt the objectives of glycemic control to the frailty profile in older patients. The purpose of this study was to evaluate the proportion of older patients with diabetes whose treatment deviates from the recommendations. (2) Methods: This cross-sectional observational study was conducted in older adults with known diabetes who underwent an outpatient frailty assessment in 2016. Glycated hemoglobin (HbA1c) target is between 6% and 7% for nonfrail patients and between 7% and 8% for frail patients. Frailty was evaluated using the Fried criteria. Prescriptions of glucose-lowering drugs were analyzed based on explicit and implicit criteria. (3) Results: Of 110 people with diabetes with an average age of 81.7 years, 67.3% were frail. They had a mean HbA1c of 7.11%. Of these patients, 60.9% had at least one drug therapy problem in their diabetes management and 40.9% were potentially overtreated. The HbA1c distribution in relation to the targets varied depending on frailty status (p < 0.002), with overly strict control in frail patients (p < 0.001). (4) Conclusions: Glycemic control does not seem to be routinely adjusted to the health of frail patients. Several factors can lead to overtreatment of these patients.
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Affiliation(s)
- Anne-Sophie Mangé
- Department of Pharmacy, Toulouse University Hospital, UPS Toulouse III Paul Sabatier University, 31000 Toulouse, France; (A.-S.M.); (P.C.); (C.M.)
| | - Arnaud Pagès
- Department of Pharmacy, Toulouse University Hospital, UPS Toulouse III Paul Sabatier University, 31000 Toulouse, France; (A.-S.M.); (P.C.); (C.M.)
- UMR 1027, Inserm, UPS Toulouse III Paul Sabatier University, 31000 Toulouse, France
- INSPIRE Project, Institute of Aging, Gérontopôle, Toulouse University Hospital, UPS Toulouse III Paul Sabatier University, 31000 Toulouse, France
- Correspondence: ; Tel.: +33-567-776-418
| | - Sandrine Sourdet
- Geriatric Department, Toulouse University Hospital, UPS Toulouse III Paul Sabatier University, 31000 Toulouse, France;
| | - Philippe Cestac
- Department of Pharmacy, Toulouse University Hospital, UPS Toulouse III Paul Sabatier University, 31000 Toulouse, France; (A.-S.M.); (P.C.); (C.M.)
- UMR 1027, Inserm, UPS Toulouse III Paul Sabatier University, 31000 Toulouse, France
| | - Cécile McCambridge
- Department of Pharmacy, Toulouse University Hospital, UPS Toulouse III Paul Sabatier University, 31000 Toulouse, France; (A.-S.M.); (P.C.); (C.M.)
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Rolland Y, Mathieu C, Tavassoli N, Berard E, Laffon de Mazières C, Hermabessière S, Houles M, Perrin A, Krams T, Qassemi S, Cambon A, Magre E, Cantet C, Charpentier S, Lauque D, Azema O, Chicoulaa B, Oustric S, McCambridge C, Gombault-Datzenko E, Molinier L, Costa N, De Souto Barreto P. Factors Associated with Potentially Inappropriate Transfer to the Emergency Department among Nursing Home Residents. J Am Med Dir Assoc 2021; 22:2579-2586.e7. [PMID: 33964225 DOI: 10.1016/j.jamda.2021.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine the factors associated with the potentially inappropriate transfer of nursing home (NH) residents to emergency departments (EDs) and to compare hospitalization costs before and after transfer of individuals addressed inappropriately vs those addressed appropriately. DESIGN Multicenter, observational, case-control study. SETTING AND PARTICIPANTS 17 hospitals in France, 1037 NH residents. MEASURES All NH residents transferred to the 17 public hospitals' EDs in southern France were systematically included for 1 week per season. An expert panel composed of family physicians, emergency physicians, geriatricians, and pharmacists defined whether the transfer was potentially inappropriate or appropriate. Residents' and NHs' characteristics and contextual factors were entered into a mixed logistic regression to determine factors associated independently with potentially inappropriate transfers. Hospital costs were collected in the national health insurance claims database for the 6 months before and after the transfer. RESULTS A total of 1037 NH residents (mean age 87.2 ± 7.1, 68% female) were transferred to the ED; 220 (21%) transfers were considered potentially inappropriate. After adjustment, anorexia [odds ratio (OR) 2.41, 95% confidence interval (CI) 1.57-3.71], high level of disability (OR 0.90, 95% CI 0.81-0.99), and inability to receive prompt medical advice (OR 1.67, 95% CI 1.20-2.32) were significantly associated with increased likelihood of potentially inappropriate transfers. The existence of an Alzheimer's disease special care unit in the NH (OR 0.66, 95% CI 0.48-0.92), NH staff trained on advance directives (OR 0.61, 95% CI 0.41-0.89), and calling the SAMU (mobile emergency medical unit) (OR 0.47, 95% CI 0.34-0.66) were significantly associated with a lower probability of potentially inappropriate transfer. Although the 6-month hospitalization costs prior to transfer were higher among potentially inappropriate transfers compared with appropriate transfers (€6694 and €4894, respectively), transfer appropriateness was not significantly associated with hospital costs. CONCLUSIONS AND IMPLICATIONS Transfers from NHs to hospital EDs were frequently appropriate. Transfer appropriateness was conditioned by NH staff training, access to specialists' medical advice, and calling the SAMU before making transfer decisions. TRIAL REGISTRATION clinicaltrials.gov, NCT02677272.
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Affiliation(s)
- Yves Rolland
- Gérontopôle, Toulouse University Hospital, Toulouse, France; INSERM, UMR 1027, Toulouse, France
| | - Celine Mathieu
- Gérontopôle, Toulouse University Hospital, Toulouse, France; CREAI-ORS Occitanie, Toulouse, France
| | - Neda Tavassoli
- Gérontopôle, Toulouse University Hospital, Toulouse, France.
| | - Emilie Berard
- Service d'Epidémiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France, UMR 1027, INSERM-Université de Toulouse III, Toulouse, France
| | | | | | - Mathieu Houles
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - Amélie Perrin
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - Thomas Krams
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - Soraya Qassemi
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | | | - Elodie Magre
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | | | - Sandrine Charpentier
- Emergency Department, University Paul Sabatier Toulouse III, Toulouse University Hospital, INSERM, UMR 1027, Toulouse, France
| | - Dominique Lauque
- Emergency Department, University Paul Sabatier Toulouse III, Toulouse University Hospital, INSERM, UMR 1027, Toulouse, France
| | - Olivier Azema
- Observatoire Régional des Urgences d'Occitanie (ORU Occitanie), Toulouse University Hospital, Toulouse, France
| | - Bruno Chicoulaa
- Département Universitaire de Médecine Générale (DUMG), Université Toulouse III, Toulouse University Hospital, Toulouse, France
| | - Stéphane Oustric
- Département Universitaire de Médecine Générale (DUMG), Université Toulouse III, Toulouse University Hospital, Toulouse, France
| | | | | | - Laurent Molinier
- INSERM, UMR 1027, Toulouse, France; Department of Medical Information (DIM), Toulouse University Hospital, Toulouse, France
| | - Nadège Costa
- INSERM, UMR 1027, Toulouse, France; Department of Medical Information (DIM), Toulouse University Hospital, Toulouse, France
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Pagès A, Roland C, Qassemi S, Abdeljalil AB, Houles M, Romain M, Toulza O, Belloc A, McCambridge C, Voisin T, Cestac P, Juillard-Condat B. Impact of a Pharmacist-included Mobile Geriatrics team intervention on potentially inappropriate drug prescribing: protocol for a prospective feasibility study (PharMoG study). BMJ Open 2020; 10:e040917. [PMID: 33268421 PMCID: PMC7713213 DOI: 10.1136/bmjopen-2020-040917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Research has shown that potentially inappropriate drug prescription (PIDP) is highly prevalent in older people. The presence of PIDPs is associated with adverse health outcomes. This study aims to evaluate the impact of a PHARmacist-included MObile Geriatrics (PharMoG) team intervention on PIDPs in older patients hospitalised in the medical, surgical and emergency departments of a university hospital. METHODS AND ANALYSIS The PharMoG study is a prospective, interventional, single-centre feasibility study describing the impact of a PharMoG team on PIDPs in older hospitalised patients. Pharmacist intervention will be a treatment optimisation (clinical medication review) based on a combination of explicit and implicit criteria to detect PIDPs. The primary outcome is the acceptance rate of the mobile team's proposed treatment optimisations related to PIDPs, measured at the patient's discharge from the department. This pharmacist will work in cooperation with the physician of the mobile geriatric team. After the intervention of the mobile geriatric team, the proposals for improving therapy will be sent to the hospital medical team caring for the patient and to the patient's attending physician. The patient will be followed for 3 months after discharge from the hospital. ETHICS AND DISSEMINATION This study was approved by the South-West and Overseas Territories II Ethics Committee. Oral consent must be obtained prior to participation, either from the patient or from the patient's representative (trusted person and/or a family member). The results will be presented at national and international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04151797.
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Affiliation(s)
- Arnaud Pagès
- Department of Pharmacy, Toulouse University Hospital, Toulouse, France
- Institute of Aging, Gérontopôle, INSPIRE project, Toulouse University Hospital, Toulouse, France
- Centre for Epidemiology and Population Health Research (CERPOP), UMR 1027, Inserm, University of Toulouse (UPS), Toulouse, France
| | - Christel Roland
- Department of Pharmacy, Toulouse University Hospital, Toulouse, France
| | - Soraya Qassemi
- Department of Pharmacy, Toulouse University Hospital, Toulouse, France
| | | | - Mathieu Houles
- Department of Geriatrics, Toulouse University Hospital, Toulouse, France
| | - Marjolaine Romain
- Department of Geriatrics, Toulouse University Hospital, Toulouse, France
| | - Olivier Toulza
- Department of Geriatrics, Toulouse University Hospital, Toulouse, France
| | - Audrey Belloc
- Department of Research and Innovation, Toulouse University Hospital, Toulouse, France
| | | | - Thierry Voisin
- Centre for Epidemiology and Population Health Research (CERPOP), UMR 1027, Inserm, University of Toulouse (UPS), Toulouse, France
- Department of Geriatrics, Toulouse University Hospital, Toulouse, France
| | - Philippe Cestac
- Department of Pharmacy, Toulouse University Hospital, Toulouse, France
- Centre for Epidemiology and Population Health Research (CERPOP), UMR 1027, Inserm, University of Toulouse (UPS), Toulouse, France
| | - Blandine Juillard-Condat
- Department of Pharmacy, Toulouse University Hospital, Toulouse, France
- Centre for Epidemiology and Population Health Research (CERPOP), UMR 1027, Inserm, University of Toulouse (UPS), Toulouse, 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 (Basel) 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Pagès A, Mazon M, Cool C, McCambridge C, Cestac P, Rouch L, Juillard-Condat B. Cost analysis of potentially inappropriate medication in older hospitalized patients. Expert Rev Pharmacoecon Outcomes Res 2019; 20:623-627. [DOI: 10.1080/14737167.2020.1678384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Arnaud Pagès
- Department of Pharmacy, CHU de Toulouse, Toulouse, France
- UMR 1027, Inserm UPS Université de Toulouse III, Toulouse, France
| | - Marine Mazon
- Department of Pharmacy, CHU de Toulouse, Toulouse, France
| | - Charlène Cool
- Department of Pharmacy, CHU de Toulouse, Toulouse, France
- UMR 1027, Inserm UPS Université de Toulouse III, Toulouse, France
| | | | - Philippe Cestac
- Department of Pharmacy, CHU de Toulouse, Toulouse, France
- UMR 1027, Inserm UPS Université de Toulouse III, Toulouse, France
| | - Laure Rouch
- Department of Pharmacy, CHU de Toulouse, Toulouse, France
- UMR 1027, Inserm UPS Université de Toulouse III, Toulouse, France
| | - Blandine Juillard-Condat
- Department of Pharmacy, CHU de Toulouse, Toulouse, France
- UMR 1027, Inserm UPS Université de Toulouse III, Toulouse, France
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Cool C, Cestac P, McCambridge C, Rouch L, de Souto Barreto P, Rolland Y, Lapeyre‐Mestre M. Reducing potentially inappropriate drug prescribing in nursing home residents: effectiveness of a geriatric intervention. Br J Clin Pharmacol 2018; 84:1598-1610. [PMID: 29607568 PMCID: PMC6005629 DOI: 10.1111/bcp.13598] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/12/2018] [Accepted: 03/02/2018] [Indexed: 11/27/2022] Open
Abstract
AIMS Potentially inappropriate drug prescribing (PIDP) is frequent in nursing home (NH) residents. We aimed to investigate whether a geriatric intervention on quality of care reduced PIDP. METHODS We performed an ancillary study within a multicentric individually-tailored controlled trial (IQUARE trial). All NH received a baseline and 18-month audit regarding drug prescriptions and other quality of care indicators. After the initial audit, NHs of the intervention group benefited of an in-site intervention (geriatric education for NH staff) provided by a geriatrician from the closest hospital. The analysis included 629 residents of 159 NHs. The main outcome was PIDP, defined as the presence of at least one of the following criteria: (i) drug with an unfavourable benefit-to-risk ratio; (ii) with questionable efficacy; (iii) absolute contraindication; (iv) significant drug-drug interaction. Multivariable multilevel logistic regression models were performed including residents and NH factors as confounders. RESULTS PIDP was 65.2% (-3.6% from baseline) in the intervention group (n = 339) and 69.9% (-2.3%) in the control group (n = 290). The intervention significantly decreased PIDP [odds ratio (OR) = 0.63; 95% confidence interval 0.40-0.99], as a special care unit in NH (OR = 0.60; (0.42 to 0.85)), and a fall in the last 12 months (OR = 0.63; 0.44-0.90). Charlson Comorbidity Index [ORCCI = 1 vs. 0 = 1.38; 0.87-2.19, ORCCI ≥ 2 vs. 0 = 2.01; (1.31-3.08)] and psychiatric advice and/or hospitalization in a psychiatric unit (OR = 1.53; 1.07-2.18) increased the likelihood of PIDP. CONCLUSION This intervention based on a global geriatric education resulted in a significant reduction of PIDP at patient level.
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Affiliation(s)
- Charlène Cool
- UMR INSERM 1027University of Toulouse IIIToulouseFrance
- Pôle Pharmacie, Centre Hospitalo‐Universitaire (CHU) de Toulouse1 avenue Jean PoulhèsF 31059ToulouseFrance
| | - Philippe Cestac
- UMR INSERM 1027University of Toulouse IIIToulouseFrance
- Pôle Pharmacie, Centre Hospitalo‐Universitaire (CHU) de Toulouse1 avenue Jean PoulhèsF 31059ToulouseFrance
| | - Cécile McCambridge
- Pôle Pharmacie, Centre Hospitalo‐Universitaire (CHU) de Toulouse1 avenue Jean PoulhèsF 31059ToulouseFrance
| | - Laure Rouch
- UMR INSERM 1027University of Toulouse IIIToulouseFrance
- Pôle Pharmacie, Centre Hospitalo‐Universitaire (CHU) de Toulouse1 avenue Jean PoulhèsF 31059ToulouseFrance
| | - Philipe de Souto Barreto
- Gérontopôle de Toulouse, Institut du VieillissementCentre Hospitalo‐Universitaire de ToulouseToulouseFrance
- UMR 7268 Aix‐Marseille, Laboratoire d'Anthropologie bioculturelle, droit, éthique et santéFrance
| | - Yves Rolland
- UMR INSERM 1027University of Toulouse IIIToulouseFrance
- Gérontopôle de Toulouse, Institut du VieillissementCentre Hospitalo‐Universitaire de ToulouseToulouseFrance
| | - Maryse Lapeyre‐Mestre
- UMR INSERM 1027University of Toulouse IIIToulouseFrance
- Service de Pharmacologie Médicale et Clinique, CIC Inserm 1436CHU de Toulouse37 Allées Jules GuesdeF 31000ToulouseFrance
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Qassemi S, Mouchoux C, Eyvrard F, Tesquet N, Rouch L, McCambridge C, Cestac P. Le bilan de médication en soins primaires chez les plus de 65 ans. Actualités Pharmaceutiques 2018. [DOI: 10.1016/j.actpha.2017.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rouch L, Farbos F, Cool C, McCambridge C, Hein C, Elmalem S, Rolland Y, Vellas B, Cestac P. Hospitalization Drug Regimen Changes in Geriatric Patients and Adherence to Modifications by General Practitioners in Primary Care. J Nutr Health Aging 2018; 22:328-334. [PMID: 29484345 DOI: 10.1007/s12603-017-0940-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate the overall rate of adherence by general practitioners (GPs) to treatment modifications suggested at discharge from hospital and to assess the way communication between secondary and primary care could be improved. DESIGN Observational prospective cohort study. SETTING Patients hospitalized from the emergency department to the acute geriatric care unit of a university hospital. PARTICIPANTS 206 subjects with a mean age of 85 years. MEASUREMENTS Changes in drug regimen undertaken during hospitalization were collected with the associated justifications. Adherence at one month by GPs to treatment modifications was assessed as well as modifications implemented in primary care with their rationale in case of non-adherence. Community pharmacists' and GPs' opinions about quality of communication and information transfer at hospital-general practice interface were investigated. RESULTS 5.5 ± 2.8 drug regimen changes were done per patient during hospitalization. The rate of adherence by GPs to treatment modifications suggested at discharge from hospital was 83%. In most cases, non-adherence by GPs to treatment modifications done during hospitalization was due to dosage adjustments, symptoms resolution but also worsening of symptoms. The last of which was particularly true for psychotropic drugs. All GPs received their patients' discharge letters but the timely dissemination still needs to be improved. Only 6.6% of community pharmacists were informed of treatment modifications done during their patients' hospitalization. CONCLUSION Our findings showed a successful rate of adherence by GPs to treatment modifications suggested at discharge from hospital, due to the fact that optimization was done in a collaborative way between geriatricians and hospital pharmacists and that justifications for drug regimen changes were systematically provided in discharge letters. Communication processes at the interface between secondary and primary care, particularly with community pharmacists, must be strengthened to improve seamless care.
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Affiliation(s)
- L Rouch
- Laure Rouch,Toulouse University Hospital, Department of Pharmacy, France,
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Perrin A, Tavassoli N, Mathieu C, Hermabessière S, Houles M, McCambridge C, Magre E, Fernandez S, Caquelard A, Charpentier S, Lauque D, Azema O, Bismuth S, Chicoulaa B, Oustric S, Costa N, Molinier L, Vellas B, Bérard E, Rolland Y. Factors predisposing nursing home resident to inappropriate transfer to emergency department. The FINE study protocol. Contemp Clin Trials Commun 2017; 7:217-223. [PMID: 29696189 PMCID: PMC5898573 DOI: 10.1016/j.conctc.2017.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 07/18/2017] [Accepted: 07/20/2017] [Indexed: 11/19/2022] Open
Abstract
Background Each year, around one out of two nursing home (NH) residents are hospitalized in France, and about half to the emergency department (ED). These transfers are frequently inappropriate. This paper describes the protocol of the FINE study. The first aim of this study is to identify the factors associated with inappropriate transfers to ED. Methods/design FINE is a case-control observational study. Sixteen hospitals participate. Inclusion period lasts 7 days per season in each center for a total period of inclusion of one year. All the NH residents admitted in ED during these periods are included. Data are collected in 4 times: before transfer in the NH, at the ED, in hospital wards in case of patient's hospitalization and at the patient's return to NH. The appropriateness of ED transfers (i.e. case versus control NH residents) is determined by a multidisciplinary team of experts. Results Our primary objective is to determine the factors predisposing NH residents to inappropriate transfer to ED. Our secondary objectives are to assess the cost of the transfers to ED; study the evolution of NH residents' functional status and the psychotropic and inappropriate drugs prescription between before and after the transfer; calculate the prevalence of potentially avoidable transfers to ED; and identify the factors predisposing NH residents to potentially avoidable transfer to ED. Discussion A better understanding of the determinant factors of inappropriate transfers to ED of NH residents may lead to proposals of recommendations of better practice in NH and would allow implementing quality improvement programs in the health organization.
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Affiliation(s)
- Amélie Perrin
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Neda Tavassoli
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Équipe Régionale Vieillissement et Prévention de La Dépendance (ERVPD), Toulouse, France
- Corresponding author. La Cité de la Santé - Équipe Régionale Vieillissement et Prévention de la Dépendance, 20 rue du Pont Saint Pierre – TSA 60033, 31059, Toulouse Cedex 9, France.
| | - Céline Mathieu
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Observatoire Régional de La Santé de Midi-Pyrénées (ORSMIP), Toulouse, France
| | | | - Mathieu Houles
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Cécile McCambridge
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Équipe Régionale Vieillissement et Prévention de La Dépendance (ERVPD), Toulouse, France
- Pôle Pharmacie, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Elodie Magre
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Pôle Pharmacie, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Sophie Fernandez
- Pôle Médecine D’Urgence, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Anne Caquelard
- Pôle Médecine D’Urgence, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Sandrine Charpentier
- Pôle Médecine D’Urgence, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- UMR 1027, INSERM - Université de Toulouse III, Toulouse, France
| | - Dominique Lauque
- Pôle Médecine D’Urgence, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- UFR Sciences Médicales, Université de Toulouse III, Toulouse, France
| | - Olivier Azema
- Observatoire Régional des Urgences de Midi-Pyrénées (ORU-MiP), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Serge Bismuth
- Département Universitaire de Médecine Générale (DUMG), Université de Toulouse III, Toulouse, France
| | - Bruno Chicoulaa
- Département Universitaire de Médecine Générale (DUMG), Université de Toulouse III, Toulouse, France
| | - Stéphane Oustric
- UMR 1027, INSERM - Université de Toulouse III, Toulouse, France
- Département Universitaire de Médecine Générale (DUMG), Université de Toulouse III, Toulouse, France
| | - Nadège Costa
- UMR 1027, INSERM - Université de Toulouse III, Toulouse, France
- Département D’Information Médicale (DIM), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Laurent Molinier
- UMR 1027, INSERM - Université de Toulouse III, Toulouse, France
- Département D’Information Médicale (DIM), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Département D’Epidémiologie, D’Economie de La Santé et de Santé Publique, Université Toulouse III, Toulouse, France
| | - Bruno Vellas
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Équipe Régionale Vieillissement et Prévention de La Dépendance (ERVPD), Toulouse, France
- UMR 1027, INSERM - Université de Toulouse III, Toulouse, France
| | - Emilie Bérard
- UMR 1027, INSERM - Université de Toulouse III, Toulouse, France
- Service D'Epidémiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Yves Rolland
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Équipe Régionale Vieillissement et Prévention de La Dépendance (ERVPD), Toulouse, France
- UMR 1027, INSERM - Université de Toulouse III, Toulouse, France
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Thorel J, McCambridge C, Piau A, Secher M, Magre É, Montastruc JL, Bagheri H. Les inhibiteurs de pompe à protons : vraie indication ou prescription banalisée ? Therapie 2016; 71:589-593. [DOI: 10.1016/j.therap.2016.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/19/2016] [Indexed: 12/18/2022]
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