Unité d’évaluation gériatrique pluriprofessionnelle dans la ville de Bordeaux : suivi des propositions d’optimisation thérapeutique par les médecins généralistes

Abstract : Introduction: the multi-professional geriatric evaluation unit in the city of Bordeaux University Hospital has been operational since September 2015 as part of the PAERPA project and offers a standardised geriatric evaluation in the elderly person's home. One of its objectives is to combat adverse drug events by proposing therapeutic optimization for the general practicionner (GP) of patients evaluated by the unit. We wanted to know the rate of follow-up of these therapeutic recommendations made by the unit. Material and Method: this is a prospective, descriptive, mono-centric study of all patients evaluated by the pluriprofessional geriatric unit of the CHU de Bordeaux from November 3, 2016 to May 30, 2017. Data were collected by telephone from reference pharmacies. Results: of the 144 patients who received an intervention from the unit, 120 are concerned by a therapeutic optimization proposal. The follow-up of therapeutic optimization proposals by GP was 63.2%. The drug classes most concerned by the optimization proposals were the nervous system class (47.4%) with 66,2% follow-up, the cardiovascular system class (22.8%) with 68,5% follow-up , the digestive tract and metabolism drug class (15.8%) with 68,1% follow-up, and the blood and hematopoietic organs drug class (5.5%) with 50% follow-up. The main optimization proposals were treatment withdrawal (47%), followed by new medication (20%) and dosage change (14%). The reasons for not following up the proposals were not linked to the patient’s or the doctor’s refusal (progression in patient’s clinical state or patient admitted to EHPAD). Among the doctor related reasons, a prescription by a specialist or forgetting modification were the main reasons. The patient's opposition to the changes mainly concerned drugs in the nervous system. Conclusion: the adherence of attending physicians to therapeutic change is important in this study. This coordination work among health professionals seems important to optimize medication prescriptions in elderly patients and improve overall management.
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Master Thesis
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Submitted on : Tuesday, February 19, 2019 - 4:40:57 PM
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Jeanne Lajus. Unité d’évaluation gériatrique pluriprofessionnelle dans la ville de Bordeaux : suivi des propositions d’optimisation thérapeutique par les médecins généralistes. Médecine humaine et pathologie. 2018. ⟨dumas-02025473⟩

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