Guaranteeing the Continuity of the Care Pathway for the Elderly Patient: Evaluation of a Territorial Approach of Clinical Pharmacy
- Conditions
- Medication Reconciliation at Discharge
- Interventions
- Other: medication reconciliation
- Registration Number
- NCT04018781
- Lead Sponsor
- Rennes University Hospital
- Brief Summary
In the context of the ageing of the French population, drug iatrogeny in the elderly is a major public health issue, responsible for approximately 7,500 deaths per year and 3.4% of hospitalizations among patients aged 65 and over.
The interest of the Medication Reconciliation (MR) in reducing medication errors and unintentional discrepancies in prescriptions at transition points in patients' medication care pathways no longer seems to be in doubt both in France and abroad.
On the other hand, the literature on the clinical impact of these drug errors (i. e. occurrence of an adverse drug event (ADE) or readmission rates) is currently limited in France and presents variable results abroad.
- Detailed Description
The medication reconciliation implementation mobilizes human resources (pharmacists, pharmacy technician, nurses...) and constitutes an investment for healthcare institutions. However, the resulting improvement in patients' health status (and the potential reduction in ADEs) could reduce their care consumption and thus reduce costs from a healthcare system perspective. We therefore propose to assess the cost-effectiveness of this care strategy.
Finally, we will study the impact of the MR deployment on existing professional organizations, both in hospital and between community healthcare professionals and hospital as well as its conditions of implementation.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 443
Not provided
Not provided
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description MR group medication reconciliation Patients who benefit from a full process of medication reconciliation (entrance and discharge) before being discharged to home. Control group medication reconciliation Patients who benefitted from a medication reconciliation at entrance only before being discharged to home.
- Primary Outcome Measures
Name Time Method Adverse drug event-related hospital revisits 30 days after discharge Rate of adverse drug event-related hospital revisits within 30 days after discharge
- Secondary Outcome Measures
Name Time Method General Practitioner consultation 30 days after discharge Rate of General Practitioner consultation within 30 days after discharge
All-causes readmissions and/or Emergency Department visits 90 days after discharge Composite rate of readmissions and/or Emergency Department visits within 90 days after discharge
Incremental Cost-Effectiveness Ratio (ICER) at Day 30 30 days after discharge Medico-economic analysis : Incremental Cost-Effectiveness Ratio (ICER) : cost per hospitalization for Drug Adverse Event avoided and cost per all-causes hospitalization, according to a collective perspective at Day 0.
Incremental Cost-Effectiveness Ratio (ICER) at Day 90 90 days after discharge Medico-economic analysis : Incremental Cost-Effectiveness Ratio (ICER) : cost per hospitalization for Drug Adverse Event avoided and cost per all-causes hospitalization, according to a collective perspective at Day 90.
Patient reported experience measures 7 days after discharge Patient reported experience measures are realized by a short phone call interview, 7 days after the patients' homecoming
Number of Unintended Medication Discrepancies At admission Number of Unintended Medication Discrepancies intercepted during medication reconciliation at admission
Impact of the implementation of the intervention on professional organizations Before and after the implementation of the intervention in the participating wards Qualitative analysis based on :
* First, an inventory of organizations prior to the implementation of the intervention in participating health facilities
* Then, an assessment of the impacts of the implementation of the intervention on different aspects of professional organizations: collaborative exchanges, multi-professional information sharing, division of labour, exchanges with city practitioners, learning effects, evolution of professional practices.Severity of Unintended Medication Discrepancies At admission Severity of Unintended Medication Discrepancies intercepted during medication reconciliation at admission
Trial Locations
- Locations (3)
General Hospital
🇫🇷Saint-Méen le Grand, France
Hopital des Marches de Bretagne
🇫🇷Antrain, France
University Hospital
🇫🇷Rennes, France