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Master Thesis

Évaluation des prescriptions médicamenteuses dans douze EHPAD Martiniquais : prévalence des prescriptions sous-optimales grâce à l’association BEERS version 2015 /START-STOPP version 2

Abstract : Background: potentially appropriate drugs (MPA) are drugs with a favorable risk / benefit ratio. In contrast, potentially inappropriate drugs (MPI) have an adverse relationship. The prescription of MPI increases morbidity and mortality. These are drugs often found in the elderly. Martinique is a department rich in patients with long-term conditions and polypathologies requiring many drugs. Purpose of the study: The objective of the study was to evaluate the prevalence of MPI and missed MPA in Martinique's nursing homes using the association between the Beers 2015 criteria and the STOPP-START version 2. Material and methods: this was a retrospective observational, multicentric study in 12 nursing homes in Martinique randomly selected by geographic area, from 180 randomly selected patients between April 10, 2018 and April 31, 2018. Inclusion criteria included all patients living permanently in long-term care homes. Exclusion criteria included patients who had not been assessed by the prescribing physician since they entered the EHPAD. Detection of MPI was done using the tool associating the criteria of Beers 2015 and STOPP version 2, and the detection of MPAs omitted using the START version 2. Primary end point: Number of residents with at least one MPI due to detection by "Beers 2015 / STOPP version 2" association and number of residents with at least one non-prescribed MPA per patient according to the START version 2 list. Results: the prevalence of patients with at least one MPI for the entire sample using the "B / S" tool was 60%, n = 108 and 74.4%, n = 134 for patients with at least MPA omitted. Across the country, for the "B / S" tool, we observed a median of 1.00 (IQ = 2.00), which meant that half of the sample had 1 or more inappropriate drugs . Also, the "B / S" test mainly identified 0 medications not appropriate for the majority of the sample (n = 72, 40.0%) and 5 medications not appropriate for a minority (n = 1, 0.6%). ). There was a clear predominance of an xiolytics and antipsychotics in inappropriate prescriptions, regardless of geographic area. Forgetting immunization prescriptions, including pneumococcal vaccination for patients with diabetes, heart failure, renal insufficiency or immunocompromised patients, was by far the largest missed MPA. Conclusion: the Beers 2015 association and STOPP-START version 2 revealed a high prevalence of MPI and a high prevalence of MPA omitted by the prescriber. The application of the STOPP-START version 2 tool in nursing homes in Martinique could lead to an improvement in medication prescriptions.
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Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Wednesday, April 22, 2020 - 3:45:57 PM
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Yoann Annette. Évaluation des prescriptions médicamenteuses dans douze EHPAD Martiniquais : prévalence des prescriptions sous-optimales grâce à l’association BEERS version 2015 /START-STOPP version 2. Médecine humaine et pathologie. 2018. ⟨dumas-02550899⟩

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