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Master Thesis

Conciliation médicamenteuse de sortie en gériatrie : impact de la transmission hôpital-ville d'un bilan médicamenteux sur le maintien des optimisations thérapeutiques

Abstract : In the Grenoble University hospital, geriatricians and pharmacists collaborate to improve drug therapies for elderly patients. Medication improvements may be threatened after discharge if no precise information about adjustments is sent to general practitioners (GP). In our geriatric unit, Pharmacy resident performs a conciliation at discharge and summarizes drug changes with justification into a medication report sent to GP. Our study aims to assess if such intervention can help keeping therapeutic improvements after hospitalization. The study included 34 patients discharged between May 2012 and October 2013. GP received the medication report by post and they were contacted to evaluate the additional changes over those set by the Hospital. Drug changes were compared with START/STOPP criteria and Beers list. In the hospital setting, 209 treatment changes were made, including 88 new prescriptions, 27 dosage modifications or substitutions, and 94 cessations. Stops were motivated by the following causes: no indication, contra-indication or inappropriate prescription, adverse effect and drug interaction. New treatments included vitamins, analgesics, laxatives, conversion enzyme inhibitors and anticoagulants. Changes were as recommended by START, STOPP or Beers for 29 patients. After discharge, 88.5% of drug adjustments were kept. Among the 11.5% changed by GP, 70.8% were clinically relevant. Most treatments were improved in hospital according to START/STOPP criteria. Systematic information of the introduced changes sent to GP could motivate them to maintain the updated treatment. We have so developed a process for performing medication report in order to extend the practice.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01021330
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Submitted on : Wednesday, September 10, 2014 - 10:22:57 AM
Last modification on : Wednesday, July 15, 2020 - 8:56:03 AM
Long-term archiving on: : Thursday, December 11, 2014 - 11:41:00 AM

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  • HAL Id : dumas-01021330, version 1

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Mélanie Moulis-Rivière. Conciliation médicamenteuse de sortie en gériatrie : impact de la transmission hôpital-ville d'un bilan médicamenteux sur le maintien des optimisations thérapeutiques. Sciences pharmaceutiques. 2014. ⟨dumas-01021330⟩

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