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

Sponsor

University Hospital, Toulouse (Other)

Overall Status

Completed

CT.gov ID

NCT04151797

Collaborator

Institut National de la Santé Et de la Recherche Médicale, France (Other)

200

Enrollment

Location

Arm

16.1

Actual Duration (Months)

12.4

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

In patients aged 75 years and older, polypathology is frequent and often associated with polypharmacy. This polypharmacy coupled with a lack of proactive elderly care can sometimes lead to hospitalisation. Due to comorbidities and complex problems, management of geriatric patients usually requires a multidisciplinary approach. In Toulouse University Hospital, elderly inpatients can benefit from a geriatric assessment by a Geriatric Mobile Team. Whether this team improve the prescriptions through the advice of a clinical pharmacist has not been demonstrated yet.

Condition or Disease	Intervention/Treatment	Phase
Medication Therapy Management	Other: Medication therapy management	N/A

Detailed Description

All participants will be identified via the geriatrician of the mobile geriatric team with the following inclusion criteria: age ≥ 75 years, ≥ 5 medications per day and being hospitalised either in emergency room, short-stay medicine unit or in a surgery department. For each patient, the pharmacist will detect potentially inappropriate prescribing (based on explicit criteria and an implicit approach) and liaise with the geriatrician for drug optimisations. The pharmaceutical advice will be added to the geriatrician's written report, and then addressed to the relevant physician. The implementation of the proposals will be evaluated immediately at the end of hospitalisation, and then reassessed three months later by calling the patient and/or his community pharmacist. A total of 250 patients will be enrolled over a 12 month-period. The evolution of potentially inappropriate prescribing will be assessed and their cost evaluated.

Study Design

Study Type:

Interventional

Actual Enrollment :

200 participants

Allocation:

N/A

Intervention Model:

Single Group Assignment

Masking:

None (Open Label)

Primary Purpose:

Supportive Care

Official Title:

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

Actual Study Start Date :

Nov 19, 2019

Actual Primary Completion Date :

Mar 22, 2021

Actual Study Completion Date :

Mar 22, 2021

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Medication therapy management Medication therapy management by pharmacist-led medication review	Other: Medication therapy management The intervention is in the form of a pharmacist-led medication review aimed at detecting potentially inappropriate prescribing. It includes: Data collection on comorbidities, medication and laboratory results. A pharmacist's evaluation of the prescriptions based on the patient's conditions and on the current recommendations for clinical practice. A detailed feedback to the geriatrician. A written report addressed to the attending physician

Arm

Intervention/Treatment

Experimental: Medication therapy management

Medication therapy management by pharmacist-led medication review

Other: Medication therapy management

The intervention is in the form of a pharmacist-led medication review aimed at detecting potentially inappropriate prescribing. It includes: Data collection on comorbidities, medication and laboratory results. A pharmacist's evaluation of the prescriptions based on the patient's conditions and on the current recommendations for clinical practice. A detailed feedback to the geriatrician. A written report addressed to the attending physician

Outcome Measures

Primary Outcome Measures

Change from baseline patients' number of potentially inappropriate prescription at the patient discharge after optimization by a mobile geriatric team with pharmacist [Month 0 and max Month 2 (At the patient discharge)]
number of potentially inappropriate prescribing per patient before (month 0) and after the intervention of the mobile geriatric team (at the patient discharge)

Secondary Outcome Measures

Change from baseline patients' number of potentially inappropriate prescription at 3 months after optimization by a mobile geriatric team with pharmacist [Month 0, Month 3]
number of potentially inappropriate prescribing per patient before (month 0) and after the intervention of the mobile geriatric team (month 3)
Change from baseline patients' number with at least one potentially inappropriate drug at 3 months after optimization by a mobile geriatric team with pharmacist [Month 0, Month 3]
number of patients with at least one potentially inappropriate drug before (month 0) and after the intervention of the mobile geriatric team (month 3)
Change from baseline ratio of potentially inappropriate drug per patient at 3 months after optimization by a mobile geriatric team with pharmacist [Month 0, Month 3]
ratio of potentially inappropriate drug per patient before (month 0) and after (month 3) the intervention of the mobile geriatric team.
Change from baseline mean number of medications per patient at 3 months [Month 0, Month 3]
Mean number of medications per patient
realisation of a pharmacist-led medication review in primary care [Month 3]
Number of pharmacist-led medication review performed in primary care at 3 months
number of falls 3 months after pharmacist-led medication review [Month 3]
Number of falls
mortality 3 months after pharmacist-led medication review [Month 3]
Number of deaths
re-hospitalisation, including emergency room transfers [Month 3]
Number of non-scheduled hospitalisations (including emergency department transfers)
The nursing home transfers [Month 3]
Number of nursing home transfers

Eligibility Criteria

Criteria

Ages Eligible for Study:

75 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Patient aged 75 or older
Having 5 medications or more per day
Being hospitalised either in emergency room, short-stay medicine unit or surgery department