A method of therapeutic optimization of prescriptions in a geriatric rehabilitation care unit

摘要

The elderly are more frequently exposed to polypharmacy and iatrogenic events, especially in this population, more sensitive to the drugs' effects (polypathology, polypharmacy). In a geriatric rehabilitation care unit where clinical pharmacy is developed (medication reconciliation), therapeutic optimization is based on Laroche list, on "AMI" criteria of the HAS and on STOPP/START list, which are used during medication review. Optimization is also based on implicit criteria and on complementarity between geriatric physicians and clinical pharmacists. The objective of this prospective descriptive study on 86 patients was to describe the therapeutic modifications and to analyze the follow-up of changes, one and three months after discharge from hospital. 275 treatments were stopped (62.9% without indication), 87 overdoses or under doses were revised, 55 with negative risk-benefit balance were stopped (20% of stopped treatments). One hundred and eleven START criteria were begun (316 treatments, 20% just for vitamin D) to fight against underuse. Explications of modifications in the medication were sent to general practitioners (GP) and community pharmacists to justify them at the end of the hospitalization. The remaining changes reached a rate of 77.9% and 71% respectively one and three months after discharge. Discontinuations of treatments initiated during hospital stay were maintained: 96% one month after discharge, 93,1% three months after.