Multidisciplinary Program "Optimization of Drug Prescription" : Impact on the Quality of Drug Prescription in Hospitalized Elderly Patients (OPMED)

OPMED STUDY: Multidisciplinary Program "Optimization of Drug Prescription" : Impact on the Quality of Drug Prescription in Hospitalized Elderly Patients

Drug prescription is a fundamental component of care for the elderly. Even if drugs are a chance for the older patient, because of changes in pharmacological, pharmacokinetic and pharmacodynamic parameters related with age and acute/or chronic pathologies, the risks associated with drug prescription, particularly those associated with potentially inappropriate medication (PIM), are increased in the elderly.

We suppose that many of hospitalized elderly have at least one prescribed medication without valid indication. Conversely, many diseases are currently undertreated in elderly patients: e.g. medicines used to treat heart failure and osteoporosis are underused in 20 to 70% of patients. Moreover, PMI prescription is associated with an increased of morbidity, mortality, risk of drug-related adverse events, utilization of health care system, care costs and impairment of quality of life. Thus, optimization of drug prescription is a major concern for improvement of the quality and safety of care in elderly.

The investigators' hypothesis is that a multidisciplinary program entitled "Optimisation de la Prescription MEDicamenteuse" ("Optimization of drug prescribing") focused on drug prescription optimization including a physician training to the specificity of the drug prescription in the elderly and a checklist allowing an adapted and standardized pharmaceutical analysis is effective in reducing PIM in elderly patients hospitalized in short-term medical and geriatric care departments.

Study Overview

• Status: Completed
• Conditions: Potentially Inappropriate Medications
• Intervention / Treatment: Other: " Optimisation de la Prescription MEDicamenteuse " ("Optimization of drug prescribing")

• Study Type: Observational
• Enrollment (Actual): 3055

Contacts and Locations

Study Locations

• France
  • Lyon, France, 69003
    • Hospices civils de Lyon - Hôpital Edouard Herriot

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 75 years and older (OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Hospitalized elderly patients from 75 years old.

Description

Inclusion Criteria:

• Male or female subject aged over 75 years hospitalized in one of the participating department
• Patient agreed to participate

Exclusion Criteria:

• Patient with a predictive length of stay equal or less than 48 hours
• Patients admitted in terminal illness

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Control group; Patients of this group are hospitalized in a time frame where the multidisciplinary intervention program is not implemented in the medical department. Drug prescriptions are conducted under usual care in the department.
Intervention group; Patients of this group are hospitalized in a time frame where the multidisciplinary intervention program is implemented in the medical department.	Other: " Optimisation de la Prescription MEDicamenteuse " ("Optimization of drug prescribing"); The multidisciplinary intervention program include: Awareness and training of doctors by two experts (a geriatrician and a pharmacist) within participating departments.; Implementation of a checklist which aims to conduct an adapted and standardized pharmaceutical analysis

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of potentially inappropriate medications (PIM) prescribed in discharge of hospitalized patients from 75 years old.	Proportion of prescribed PIM will be expressed as the ratio of PIM to the total number of medication in discharge prescription sheet. PIM will be identified by 2 experts (1 doctor and 1 pharmacist) based on criteria from the lists STOPP/START and Laroche.	at discharge (average 3 weeks)

Secondary Outcome Measures

Outcome Measure	Time Frame
Total number of drugs prescribed per discharge prescription sheet	at discharge (average 3 weeks)
Number of rehospitalization within 12 months following discharge	12 months after inclusion
Number of emergency admission within 12 months following hospitalization	12 months after inclusion
Mortality within 12 months after hospitalization	12 months after inclusion

Collaborators and Investigators

• Sponsor: Hospices Civils de Lyon

Study record dates

Study Major Dates

• Study Start (ACTUAL): January 1, 2013
• Primary Completion (ACTUAL): June 1, 2017
• Study Completion (ACTUAL): June 1, 2017

Study Registration Dates

• First Submitted: July 26, 2013
• First Submitted That Met QC Criteria: September 19, 2013
• First Posted (ESTIMATE): September 20, 2013

Study Record Updates

• Last Update Posted (ACTUAL): September 28, 2017
• Last Update Submitted That Met QC Criteria: September 27, 2017
• Last Verified: September 1, 2017

More Information

Terms related to this study

• Keywords: Elderly; Prevention; Checklist; Stepped wedge design; Potentially inappropriate medications; Multidisciplinary program; AGED, 75 AND OVER
• Other Study ID Numbers: D50789