Long-term results of a multidisciplinary medication optimization program for older adults including primary care and hospital team.

IF 2.7 3区医学 Q3 PHARMACOLOGY & PHARMACY

European Journal of Clinical Pharmacology Pub Date : 2025-07-28 DOI:10.1007/s00228-025-03889-5

Camille Guerin, Romain Leguillon, Albane Cherel, Lucie Valembois, Gwladys Brochard, Mélissa Pierre, Antoine Bourderont, Bérénice Gaillot, Claire Bernardeau, Céline Vaesken, Ines Tebourski, Pablo Descatoire, Guillaume Saint-Lorant, Cédric Villain, Alexandre Meurant

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引用次数: 0

Abstract

Background: Therapeutic optimization and deprescribing in older adults face multiple barriers, whereas drug-related hospitalization increased from 3.6% to 8.5% between 2006 and 2018. The OPTIMEDOC program aims to optimize older adults' prescriptions through clinical medication review conducted by a multidisciplinary team including clinical pharmacist, geriatrician, and general practitioner (GP). This collaboration between primary care and hospital team aims to enable appropriate and sustainable prescriptions.

Purpose: This study aimed to assess the implementation of therapeutic optimizations at least 6 months after the intervention. The secondary objective was to document the most frequently deprescribed and newly introduced medications and their long-term implementation rate.

Methods: This observational study was conducted in a university hospital, including patients who benefited from the OPTIMEDOC program from April 2022 to April 2024. The primary outcome was the long-term implementation rate of recommendations. The secondary outcome was a description of the optimized drugs according to ATC2 classes.

Results: Among 1580 validated therapeutic recommendations for 143 patients included with an average age of 86.4 years old, 1473 were followed up (93.2%). Of these, 1017 were successfully implemented over 1 year (69.0%). Specifically, 81.8% of deprescriptions, 58.3% of introductions, and 70.5% of modifications were implemented. Although vaccine introductions were the most frequently recommended (n = 222), only 41% were implemented. Regarding deprescribing, psycholeptics, psychoanaleptics, and drugs for acid-related disorders had a long-term implementation rate of over 75%.

Conclusion: These results validate the OPTIMEDOC program as an effective strategy for sustainable therapeutic optimization, especially for deprescribing. Engaging community pharmacists could further enhance the implementation of therapeutic recommendations.

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包括初级保健和医院团队在内的老年人多学科药物优化方案的长期结果。

背景：老年人的治疗优化和处方化面临多重障碍，而2006年至2018年间，与药物相关的住院率从3.6%增加到8.5%。OPTIMEDOC项目旨在通过临床药师、老年医学专家和全科医生（GP）等多学科团队进行的临床药物审查，优化老年人的处方。初级保健和医院团队之间的这种合作旨在提供适当和可持续的处方。目的：本研究旨在评估干预后至少6个月的治疗优化实施情况。次要目的是记录最常用的处方和新引入的药物及其长期执行率。方法：本观察性研究在一所大学医院进行，纳入了2022年4月至2024年4月期间受益于OPTIMEDOC计划的患者。主要结果是建议的长期执行率。次要终点是根据ATC2分类对优化药物的描述。结果：纳入的143例患者1580条有效的治疗建议中，平均年龄86.4岁，随访1473例（93.2%）。其中，1017例在1年内成功实施（69.0%）。具体而言，81.8%的去处方、58.3%的引入和70.5%的修改得到了实施。虽然引入疫苗是最常被推荐的（n = 222），但只有41%得到了实施。在处方方面，抗精神病药、精神镇痛药和抗酸相关障碍药物的长期执行率超过75%。结论：这些结果验证了OPTIMEDOC程序是持续优化治疗的有效策略，特别是在处方方面。社区药剂师的参与可以进一步加强治疗建议的实施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Clinical Pharmacology 医学-药学

CiteScore

5.40

自引率

3.40%

发文量

170

审稿时长

3-8 weeks

期刊介绍： The European Journal of Clinical Pharmacology publishes original papers on all aspects of clinical pharmacology and drug therapy in humans. Manuscripts are welcomed on the following topics: therapeutic trials, pharmacokinetics/pharmacodynamics, pharmacogenetics, drug metabolism, adverse drug reactions, drug interactions, all aspects of drug development, development relating to teaching in clinical pharmacology, pharmacoepidemiology, and matters relating to the rational prescribing and safe use of drugs. Methodological contributions relevant to these topics are also welcomed. Data from animal experiments are accepted only in the context of original data in man reported in the same paper. EJCP will only consider manuscripts describing the frequency of allelic variants in different populations if this information is linked to functional data or new interesting variants. Highly relevant differences in frequency with a major impact in drug therapy for the respective population may be submitted as a letter to the editor. Straightforward phase I pharmacokinetic or pharmacodynamic studies as parts of new drug development will only be considered for publication if the paper involves -a compound that is interesting and new in some basic or fundamental way, or -methods that are original in some basic sense, or -a highly unexpected outcome, or -conclusions that are scientifically novel in some basic or fundamental sense.