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Master Thesis

Mesure des erreurs de compréhension de la prescription lors de la substitution médicamenteuse‎ : enquête de patients dans les pharmacies de l'agglomération grenobloise en 2013

Abstract : Introduction-- In France, drug's substitution is already systematic, unless specifically mentioned. Understanding one's prescription is the first step to an appropriate medication use. But after a drug substitution, can a patient clearly identify his prescription? Design-- prospective study led by structured interviews of autonomous patients after they received their personal prescription in random pharmacies and statistical analysis. Methods-- The aim of this study is to evaluate the incidence of prescription misunderstanding among patients after drug substitutions in pharmacies and second to identify high risk patients. Patients were asked to match their medications with their prescription (errors of identification outcome of interest), to recall the indications and the instructions of their medications. Results-- A hundred and forty three independent adults with a mean age of 60.9 years were questioned about 627 drugs (314 substituted drugs). A hundred and thirty one errors of identification, frequency, dosage, duration, and precautions of different drugs (and among them 67 were substituted drugs) for 70 different patients were found. Among 23 identification's errors, 19 errors linked to substituted drugs were made by 16 patients (11.1%). The number of errors is correlated with an increased number of substitutions per patient (p=0.014). Patients make more errors of identification with substituted drugs (p < 0.002), the higher the number of substitutions (p=0.005) and a higher number of medicines (p=0.002). These mistakes are linked to a misunderstanding of drug indication (p= 4.4.10-12), old age (p=0.007), a low education level (p < 0.05) and a handwriting prescription (p=0.02). Patients who make at least one error per prescription (without the precaution's errors) know significantly less the indications of the drugs (p < 0.002), have a more complex dosing schedule (p < 0.00001), more delivered medicines (p=0.013) and more incorrectly prescribed substituted medicines (in France that means the substituted medicine were named by their brand's name instead of their INN's name or generic's name p=0.04). Conclusion-- Generic's substitution may lead to confusions as any therapeutic change. This misunderstandings can probably be prevented by an evaluation of the patient's medication knowledge and with appropriate education.
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Master Thesis
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Submitted on : Wednesday, November 27, 2013 - 4:59:14 PM
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Florence Roffé. Mesure des erreurs de compréhension de la prescription lors de la substitution médicamenteuse‎ : enquête de patients dans les pharmacies de l'agglomération grenobloise en 2013. Médecine humaine et pathologie. 2013. ⟨dumas-00910288⟩

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