Séances pluridisciplinaires de révision d’ordonnances en gériatrie à l’hôpital : bilan et perspectives

Abstract

Objective: Drug–related iatrogeny is a leading subject in the management of elderly subjects. In this study, we describe one year of multidisciplinary medication reviews in a geriatric population.Methods: The pharmacist pre-analyzes patient records from geriatric services (rehabilitation and homes for the dependent elderly) before the multidisciplinary session. Post-session, a report summarizes prescription modifications. A file collects data on the time spent on the activity, the nature and number of pharmaceutical interventions, and the cost of the prescription before and after medication review. This data describes the medication review activity over the year 2022.Results: A total of 116 prescriptions were reviewed during the 46 sessions carried out over the year 2022. The average time per patient in a review session was 16.9 minutes [10 min; 35 min], with a total pharmaceutical time of 1 hour and 37 minutes [42 min; 2h53]. The average number of lines of prescribed treatments before review was 13.4 lines [4; 27], reduced to 11.9 lines [3; 22] post-revision, with nearly a third of the medications prescribed "as-needed". Most therapeutic modifications involved discontinuation of treatments. Pharmaceutical interventions had an overall acceptance rate of 74.3%. These sessions resulted in annual savings of euro6052.06 on medication.Discussion: Medication review sessions contribute to optimizing therapeutic care for the elderly but require significant pharmaceutical time. Only 17.4% of the total time is allocated to the multidisciplinary session. Time is a critical parameter to perpetuate this activity. The constant evolution of patients requires regular prescription review sessions. Multidisciplinarity is essential, as some crucial information is known only by nurses. The savings generated are hard to quantify, as estimates are limited to savings from non-consumed medications, excluding the potential benefits of avoidance of iatrogenic events.Conclusion: Prescription review sessions are tools contributing to continuous improvement in the quality of medical management for the elderly by way of therapeutic optimization. Although necessary, their deployment requires significant pharmaceutical time.