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Master Thesis

Revue de pertinence pluridisciplinaire des prescriptions médicamenteuses : optimisation de la prise en charge des résidents de l’EHPAD

Abstract : Introduction: The occurrence of pathophysiological changes, coupled with an increased risk of drug interactions, increases the exposure of the elderly population to drug iatrogenicity, and also increases the deleterious effects of drug iatrogeny. It is therefore essential to review regularly and optimize the prescription of elderly subjects. Objective: The goal of this work is to optimise the care of retirement home residents by setting up a multidisciplinary group to review the relevance of prescriptions (RRP), and to assess the impact of this approach. Material and method: We carried out an observational, longitudinal and mono-centric study over a five-month period that included 43 residents. The RRP was carried out for each patient in 3 stages: pharmaceutical analysis, multidisciplinary meeting and reassessment at 1 month. Results: The implementation of the multidisciplinary RPP resulted in a significant reduction in the number of drugs per prescription. A decrease of 30.7% was observed, which, after a one-month period, stabilized at 37.3%. The number of potentially inappropriate medications also declined significantly. With regard to the Laroche criteria, there was a decrease of 59.5% and then 70.3% after one month. For the STOPP criteria, a decrease of 62.4% was confirmed at one month (67.3%). Among the drugs stopped or substituted, some had anticholinergic or sedative properties, leading to a decrease in the DBI score of 41.25% then 45% at 1 month. As far as under-prescription is concerned, 54 START criteria were identified. Conclusion: These positive results highlight the importance of both multidisciplinary RRP and implication of each actor in optimising drug management. However, this time-consuming activity requires a reflection on the priorisation of patients. This would allow, by extending this process to other sectors, to initiate an improvement in professional practices.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02936519
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Submitted on : Friday, September 11, 2020 - 1:18:19 PM
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Mathilde Andre. Revue de pertinence pluridisciplinaire des prescriptions médicamenteuses : optimisation de la prise en charge des résidents de l’EHPAD. Sciences du Vivant [q-bio]. 2020. ⟨dumas-02936519⟩

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