Interdisciplinary geriatric and psychiatric care reduces potentially inappropriate prescribing in the hospital: interventional study in 150 acutely ill elderly patients with mental and somatic comorbid conditions.

Détails

ID Serval
serval:BIB_91CF01903D06
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Interdisciplinary geriatric and psychiatric care reduces potentially inappropriate prescribing in the hospital: interventional study in 150 acutely ill elderly patients with mental and somatic comorbid conditions.
Périodique
Journal of the American Medical Directors Association
Auteur(s)
Lang P.O., Vogt-Ferrier N., Hasso Y., Le Saint L., Dramé M., Zekry D., Huber P., Chamot C., Gattelet P., Prudent M., Gold G., Michel J.P.
ISSN
1538-9375 (Electronic)
ISSN-L
1525-8610
Statut éditorial
Publié
Date de publication
2012
Peer-reviewed
Oui
Volume
13
Numéro
4
Pages
406.e1-406.e7
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't Publication Status: ppublish
Résumé
BACKGROUND: Potentially inappropriate medications and prescription omissions (PO) are highly prevalent in older patients with mental comorbidities.
OBJECTIVE: To evaluate the effect of interdisciplinary geriatric and psychiatric care on the appropriateness of prescribing.
DESIGN: Prospective and interventional study.
SETTING: Medical-psychiatric unit in an academic geriatric department.
PARTICIPANTS: Participants were 150 consecutive acutely ill patients aged on average 80.0 ± 8.1 years suffering from mental comorbidities and hospitalized for any acute somatic condition.
INTERVENTION: From admission to discharge, daily collaboration provided by senior geriatrician and psychiatrist working in a usual geriatric interdisciplinary care team.
MEASUREMENTS: Potentially inappropriate medications and PO were detected and recorded by a trained independent investigator using STOPP/START criteria at admission and discharge.
RESULTS: Compared with admission, the intervention reduced the total number of medications prescribed at discharge from 1347 to 790 (P < .0001) and incidence rates for potentially inappropriate medications and PO reduced from 77% to 19% (P < .0001) and from 65% to 11% (P < .0001), respectively. Independent predictive factors for PIP at discharge were being a faller (odds ratio [OR] 1.85; 95% confidence interval [CI] 1.43-2.09) and for PO, the increased number of medications (OR 1.54; 95% CI 1.13-1.89) and a Charlson comorbidity index greater than 2 (OR 1.85; 95% CI 1.38 - 2.13). Dementia and/or presence of psychiatric comorbidities were predictive factors for both potentially inappropriate medications and PO at discharge.
CONCLUSION: These findings hold substantial promise for the prevention of IP and OP in such a comorbid and polymedicated population. Further evaluations are, however, still needed to determine if such an intervention reduces potentially inappropriate prescribing medication-related outcomes, such as incidence of adverse drug events, rehospitalization, or mortality.
Mots-clé
Academic Medical Centers, Acute Disease/therapy, Aged, Aged, 80 and over, Chronic Disease, Cognition Disorders/diagnosis, Cognition Disorders/drug therapy, Comorbidity, Drug-Related Side Effects and Adverse Reactions, Female, Follow-Up Studies, Geriatric Assessment/methods, Geriatrics/methods, Hospitalization/statistics & numerical data, Humans, Inappropriate Prescribing/adverse effects, Inappropriate Prescribing/statistics & numerical data, Interdisciplinary Communication, Intervention Studies, Male, Medication Errors/prevention & control, Medication Errors/statistics & numerical data, Mental Disorders/drug therapy, Mental Disorders/epidemiology, Needs Assessment, Pharmaceutical Preparations/administration & dosage, Prevalence, Prospective Studies, Psychiatry/methods, Quality Control, Severity of Illness Index, Treatment Outcome
Pubmed
Web of science
Création de la notice
15/04/2015 9:22
Dernière modification de la notice
20/08/2019 15:54
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