Description et intérêt d’un dispositif collaboratif multidisciplinaire pour améliorer les pratiques de prescriptions médicamenteuses en hôpital de jour pour adolescents

A quantitative assessment of drug prescriptions was carried out in a day hospital for adolescents following several cases of drug iatrogenia and lack of therapeutic response to treatment. These data – which are consistent with the literature on the frequency, age of introduction and off-label prescribing in child psychiatry – prompted the unit to set up a working group in 2020 to monitor drug prescriptions, including the pharmacy and the pharmacokinetics laboratory at the hospital and university centre. The main aim of this work was to highlight the improvements in how adolescents are treated for drug-related problems, thanks to this multidisciplinary approach, in terms of the improvements proposed and the resulting clinical benefits. In practice, a meeting was organised every six months at the day hospital to discuss one or two complex situations. The doctor and nurses described the clinical context and explained the difficulties. The pharmacist carried out a drug history and an in-depth analysis of the prescription and provided information on good practice. The biologist analysed the results of plasma pharmacological assays and made recommendations. A review of the literature could also have been carried out. The doctor recorded these discussions in the patient file and involved the teenager and his or her legal representatives in the conclusions of the meeting and the resulting therapeutic choices. This decision-making aid means that a specific, collegial period of reflection can be devoted to drug prescribing, and it provides a better framework for therapeutic strategies, especially outside the scope of marketing authorization. Abnormalities in the metabolism of psychotropic drugs have been identified. This meeting can also contribute to the development of new skills. We propose to highlight how this working method helps to improve the quality, effectiveness and safety of drug prescribing.