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Master Thesis

Co-prescriptions médicamenteuses inappropriées chez les sujets âgés : étude à partir des données de l’Assurance Maladie française

Abstract : Introduction: polypharmacy and co-morbidities in elderly subjects promote the occurrence of drug interactions. This work analyses inappropriate co-prescriptions in subjects aged 75 years and over in France and measures the impact of published recommendations on the basis of French Health Insurance data. Methods: the indicators were selected with a committee of experts. The prevalence of elderly subjects exposed to selected co-prescription indicators was calculated monthly from 2007 to 2015. An Interrupted Time Series model allowed to assess the impact of publication of good practice recommendations on the prevalence of these indicators. For the most frequent indicators, a cohort study analysed recurrences and hospitalisations related to co-prescription amongst incidental subjects between 2008 and 2015. Results: 30% of subjects were exposed to inappropriate co-prescription according to our indicators. From 2007 to 2015, 21.5% of subjects were exposed to the co-prescription of NSAID with ACE inhibitors or ARBs, 5.5% to co-prescription of at least two anticholinergics and 3.8% to the association of metformin and NSAID. Other indicators presented a lower prevalence. All indicators decreased over time except for the combination of at least three oral antidiabetic drugs. Only two interventions were followed by a significant effect on the prevalence of the indicators but delayed over time. The co-prescription of NSAID with ACE inhibitors or ARBs was recurrent over time, sometimes for several years with 0.11% of incident subjects hospitalized for acute renal failure and 0.03% who died during hospitalisation. Discussion: the low prevalence of subjects exposed for five of the six indicators indicates prescriptions in line with applicable good practices except for the co-prescription of NSAID with ACE inhibitor or ARBs, recurrent over time. Publications of recommendations for good practices seem to be followed by a limited variation on the level of inappropriate co- prescriptions which were evaluated.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01781783
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Submitted on : Monday, April 30, 2018 - 4:57:29 PM
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Athénaïs Lair. Co-prescriptions médicamenteuses inappropriées chez les sujets âgés : étude à partir des données de l’Assurance Maladie française. Médecine humaine et pathologie. 2018. ⟨dumas-01781783⟩

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