How a Patient Personalised Clinical Pharmacy Programme Can Secure Therapeutic Care in an Orthogeriatric Care Pathway (5P Project)?

Barral, Marine; Martin, Julie; Carre, Emmanuelle; Janoly-Dumenil, Audrey; Ranchon, Florence; Parat, Stéphanie; Rioufol, Catherine; Goutelle, Sylvain; Bourguignon, Laurent; Novais, Teddy; Doh, Sebastien; Malatray, Matthieu; Chaudier, Philippe; Gauthier, Jérome; Pivot, Christine; Mouchoux, Christelle; Hoegy, Delphine

doi:10.2147/CIA.S325035

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How a Patient Personalised Clinical Pharmacy Programme Can Secure Therapeutic Care in an Orthogeriatric Care Pathway (5P Project)?

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Author(s): Marine Barral ¹ , Julie Martin ¹ , Emmanuelle Carre ² , Audrey Janoly-Dumenil ³ ^, ⁴ ^, ⁵ , Florence Ranchon ² ^, ⁴ ^, ⁶ , Stéphanie Parat ² , Catherine Rioufol ² ^, ⁴ ^, ⁶ , Sylvain Goutelle ⁴ ^, ⁷ ^, ⁸ , Laurent Bourguignon ⁴ ^, ⁷ ^, ⁸ , Teddy Novais ⁴ ^, ⁹ ^, ¹⁰ , Sebastien Doh ¹¹ , Matthieu Malatray ¹² , Philippe Chaudier ¹³ , Jerome Gauthier ¹⁴ , Christine Pivot ³ , Christelle Mouchoux ⁴ ^, ⁹ ^, ¹⁵ , Delphine Hoegy ¹ ^, ⁴ ^, ⁵ , On behalf of 5P Study Group

Publication date (Electronic): 21 October 2021

Journal: Clinical Interventions in Aging

Publisher: Dove

Keywords: hip fracture, frail elderly, pharmaceutical services, medication errors, clinical relevance

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Abstract

Background

A new model was developed for integrating a personalised clinical pharmacy programme (5P project) into the orthogeriatric care pathway.

Objective

To secure the therapeutic care of orthogeriatric patients.

Design and Setting

Prospective descriptive study in a multisite teaching hospital from June 2019 to January 2020.

Subjects

Patients aged ≥75 years admitted for hip fracture.

Methods

A prescription review was performed for all patients at inclusion. Other clinical pharmacy activities (additional prescription review, pharmaceutical interviews, medication reconciliation) were dedicated to “high-risk” patients. Potential medication errors (ME), either pharmaceutical interventions (PI) or unintentional discrepancies (UID), were recorded. The potential clinical impact of PI was evaluated by a pluriprofessional expert panel using a validated tool.

Results

In the 455 patients included, 955 potential ME were detected, that is ≥1 potential ME for 324/455 (71%) patients. In acute care, 561 PI were formulated during prescription review for 440/455 (97%) patients and 348/561 (62%) were accepted by physicians. Medication reconciliation was performed for 213 patients, 316 UID were identified. In rehabilitation units, a second prescription review was performed for 112/122 (92%) “high-risk” patients, leading to 61 PI. The clinical impact was evaluated for 519/622 (83%) PI. A consensus was obtained for 310/519 (60%) PI: 147/310 (47%) were rated as having minor clinical impact, 138/310 (45%) moderate, 22/310 (7%) major, 2/310 (0.6%) vital, and 1/310 (0.3%) null.

Conclusion

The 5P project secured the orthogeriatric care pathway by detecting a great number of potential ME, including PI mostly considered as having a significant clinical impact.

Most cited references 21

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Epidemiology and social costs of hip fracture

Stefania Maggi, Nicola Veronese (2018)

Hip fracture is an important and debilitating condition in older people, particularly in women. The epidemiological data varies between countries, but it is globally estimated that hip fractures will affect around 18% of women and 6% of men. Although the age-standardised incidence is gradually falling in many countries, this is far outweighed by the ageing of the population. Thus, the global number of hip fractures is expected to increase from 1.26 million in 1990 to 4.5 million by the year 2050. The direct costs associated with this condition are enormous since it requires a long period of hospitalisation and subsequent rehabilitation. Furthermore, hip fracture is associated with the development of other negative consequences, such as disability, depression, and cardiovascular diseases, with additional costs for society. In this review, we show the most recent epidemiological data regarding hip fracture, indicating the well-known risk factors and conditions that seem relevant for determining this condition. A specific part is dedicated to the social costs due to hip fracture. Although the costs of hip fracture are probably comparable to other common diseases with a high hospitalisation rate (e.g. cardiovascular disease), the other social costs (due to onset of new co-morbidities, sarcopenia, poor quality of life, disability and mortality) are probably greater.

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Osteoporosis in the European Union: a compendium of country-specific reports

A Svedbom, E. Hernlund, M Ivergård … (2013)

Summary This report describes epidemiology, burden, and treatment of osteoporosis in each of the 27 countries of the European Union (EU27). Introduction In 2010, 22 million women and 5.5 million men were estimated to have osteoporosis in the EU; and 3.5 million new fragility fractures were sustained, comprising 620,000 hip fractures, 520,000 vertebral fractures, 560,000 forearm fractures and 1,800,000 other fractures. The economic burden of incident and prior fragility fractures was estimated at € 37 billion. Previous and incident fractures also accounted for 1,180,000 quality-adjusted life years lost during 2010. The costs are expected to increase by 25 % in 2025. The majority of individuals who have sustained an osteoporosis-related fracture or who are at high risk of fracture are untreated and the number of patients on treatment is declining. The aim of this report was to characterize the burden of osteoporosis in each of the EU27 countries in 2010 and beyond. Methods The data on fracture incidence and costs of fractures in the EU27 were taken from a concurrent publication in this journal (Osteoporosis in the European Union: Medical Management, Epidemiology and Economic Burden) and country specific information extracted. Results The clinical and economic burden of osteoporotic fractures in 2010 is given for each of the 27 countries of the EU. The costs are expected to increase on average by 25 % in 2025. The majority of individuals who have sustained an osteoporosis-related fracture or who are at high risk of fracture are untreated and the number of patients on treatment is declining. Conclusions In spite of the high cost of osteoporosis, a substantial treatment gap and projected increase of the economic burden driven by aging populations, the use of pharmacological prevention of osteoporosis has decreased in recent years, suggesting that a change in healthcare policy concerning the disease is warranted.

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Potentially inappropriate medications in the elderly: a French consensus panel list.

Marie-Laure Laroche, Jean-Pierre Charmes, Louis Merle (2007)

To evaluate drug-related problems in the elderly, various lists of potentially inappropriate medications have been published in North America. Unfortunately, these lists are hardly applicable in France. The purpose of this study was to establish a list of inappropriate medications for French elderly using the Delphi method. A two-round Delphi method was used to converge to an agreement between a pool of 15 experts from various parts of France and from different backgrounds (five geriatricians, five pharmacologists, two pharmacists, two general practitioners, one pharmacoepidemiologist). In round one, they were sent a questionnaire based on a literature review listing medications and clinical situations. They were asked to comment on the potential inappropriateness of the criteria proposed using a 5-point Likert scale (from strong agreement to strong disagreement) and to suggest therapeutic alternatives and new criteria. In round two, the experts confirmed or cancelled their previous answers from the synthesis of the responses of round one. After round two, a final list of potentially inappropriate drugs was established. The final list proposed 36 criteria applicable to people >/=75 years of age. Twenty-nine medications or medication classes applied to all patients, and five criteria involved medications that should be avoided in specific medical conditions. Twenty-five medications or medication classes were considered with an unfavourable benefit/risk ratio, one with a questionable efficacy and eight with both unfavourable benefit/risk ratio and questionable efficacy. This expert consensus should provide prescribers with an epidemiological tool, a guideline and a list of alternative therapies.

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Author and article information

Journal

Journal ID (nlm-ta): Clin Interv Aging

Journal ID (iso-abbrev): Clin Interv Aging

Journal ID (publisher-id): cia

Title: Clinical Interventions in Aging

Publisher: Dove

ISSN (Print): 1176-9092

ISSN (Electronic): 1178-1998

Publication date (Electronic): 21 October 2021

Publication date Collection: 2021

Volume: 16

Pages: 1857-1867

Affiliations

[1 ]Pharmacie, Hospices Civils de Lyon , Lyon, France

[2 ]Pharmacie Hôpital Lyon Sud, Hospices Civils de Lyon , Pierre-Bénite, France

[3 ]Pharmacie Hôpital Edouard Herriot, Hospices Civils de Lyon , Lyon, France

[4 ]Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1 , Lyon, France

[5 ]6-EA 4129 P2S Parcours Santé Systémique- Univ Claude Bernard Lyon 1, Univ Lyon 1 , Lyon, France

[6 ]EA3738, CICLY Centre pour l’Innovation en cancérologie de Lyon, Univ Claude Bernard Lyon 1, Univ Lyon 1 , Lyon, France

[7 ]Pharmacie Hôpital Pierre Garraud, Hospices Civils de Lyon , Lyon, France

[8 ]CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive , Villeurbanne, France

[9 ]Pharmacie Hôpital des Charpennes, Hospices Civils de Lyon , Villeurbanne, France

[10 ]Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290 , Lyon, France

[11 ]Service de Gériatrie Hôpital Edouard Herriot, Hospices Civils de Lyon , Lyon, France

[12 ]Service de Chirurgie Orthopédique Hôpital Edouard Herriot, Hospices Civils de Lyon , Lyon, France

[13 ]Service de Chirurgie Orthopédique Hôpital Lyon Sud, Hospices Civils de Lyon , Pierre-Bénite, France

[14 ]Service d’anesthésie et réanimation Hôpital Lyon Sud, Hospices Civils de Lyon , Pierre-Bénite, France

[15 ]Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR5292 , Lyon, France

Author notes

Correspondence: Delphine Hoegy Hôpital Edouard Herriot, Groupement Hospitalier Centre, Hospices Civils de Lyon , 5 Place d’Arsonval, Lyon, 69003, France Tel +33 4 72 11 91 82 Fax +33 4 72 11 78 76 Email delphine.hoegy@chu-lyon.fr

[*]

These authors contributed equally to this work.

Author information

Delphine Hoegy http://orcid.org/0000-0002-8659-6073

Article

Publisher ID: 325035

DOI: 10.2147/CIA.S325035

PMC ID: 8544550

PubMed ID: 34707352

SO-VID: 9d1bab3b-a32c-4a78-90cd-5c7166a37393

License:

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

History

Date received : 19 June 2021

Date accepted : 23 September 2021

Page count

Figures: 2, Tables: 10, References: 21, Pages: 11

Funding

Funded by: French Health ministry;

This study was supported by a national public funding from the French Health ministry (winner of the 2017 national call for project in clinical pharmacy from the Direction Générale de l’Offre de Soins). It permitted to hire two full time pharmacists in charge of the implementation and achievement of pharmaceutical activities, and coordination of the 5P project.

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Clinical Interventions in Aging (submit here)

How a Patient Personalised Clinical Pharmacy Programme Can Secure Therapeutic Care in an Orthogeriatric Care Pathway (5P Project)?

Read this article at

Abstract

Background

Objective

Design and Setting

Subjects

Methods

Results

Conclusion

Most cited references 21

Epidemiology and social costs of hip fracture

Osteoporosis in the European Union: a compendium of country-specific reports

Potentially inappropriate medications in the elderly: a French consensus panel list.

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Journal

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Author notes

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History

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Cited by 2

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