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Copyright of Gériatrie et Psychologie Neuropsychiatrie du Vieillissement is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

What is known and objective: The orthogeriatric path (hip‐fractured elderly patients) is composed of several transition points (emergency surgery, orthopaedic, geriatric and rehabilitation units). The intervention of clinical pharmacists can ensure the continuity of patients' drug management during their hospital stay. The aim of the study was to assess the implementation of clinical pharmacy activities in an orthogeriatric pathway, regarding its impact on medication error prevention, the healthcare professionals' and patients' satisfaction, and the estimated associated pharmaceutical workload. Methods: Participants were aged 75 or older and managed for proximal femoral fracture. Their admission prescription was reviewed. If they were evaluated at high risk of adverse event (AE), medication reconciliation (MedRec) and pharmaceutical interviews (admission, discharge, and targeted on oral anticoagulant) were added at different steps of their care pathway. The achievement and duration of each clinical pharmacy activity were recorded. The number of pharmaceutical interventions (PI) made during prescription review, and unintentional discrepancies (UID) identified during MedRec were collected. A satisfaction questionnaire was sent to patients and healthcare professionals. Results and discussion: Among 455 included patients, 284 patients were considered at high risk of AE. Clinical pharmacy activity achievement rates varied between 12% and 98%. A total of 622 PI and 333 UID were identified. The overall patients' and healthcare professionals' satisfaction was rated from 63% to 100%. The total workload was estimated at 376 h: on average 16 min per prescription review, 43 min per admission MedRec, 26 min per discharge MedRec and 17 to 25 minutes per interview. Conclusion: The implementation of the programme showed a high potential of drug management securing. To sustain it, additional pharmaceutical human resources and high‐performance computing tools are needed. [ABSTRACT FROM AUTHOR]

Abstract Background Postoperative delirium is common in the elderly and is associated with a significant increase in mortality, complications, length of hospital stay and admission in long care facility. Although several interventions have proved their effectiveness to prevent it, the Cochrane advises an assessment of multifaceted intervention using rigorous methodology based on randomized study design. Our purpose is to present the methodology and expected results of the CONFUCIUS trial, which aims to measure the impact of a multifaceted program on the prevention of postoperative delirium in elderly. Method/Design Study design is a stepped wedge cluster randomized trial within 3 surgical wards of three French university hospitals. All patients aged 75 and older, and admitted for scheduled surgery will be included. The multifaceted program will be conducted by mobile geriatric team, including geriatric preoperative consultation, training of the surgical staff and implementation of the Hospital Elder Life Program, and morbidity and mortality conference related to delirium cases. The primary outcome is based on postoperative delirium rate within 7 days after surgery. This program is planned to be implemented along four successive time periods within all the surgical wards. Each one will be affected successively to the control arm and to the intervention arm of the trial and the order of program introduction within each surgical ward will be randomly assigned. Based on a 20% reduction of postoperative delirium rate (ICC = 0.25, α = 0.05, β = 0.1), three hundred sixty patients will be included i.e. thirty patients per service and per time period. Endpoints comparison between intervention and control arms of the trial will be performed by considering the cluster and time effects. Discussion Better prevention of delirium is expected from the multifaceted program, including a decrease of postoperative delirium, and its consequences (mortality, morbidity, postoperative complications and length of hospital stay) among elderly patients. This study should allow better diagnosis of delirium and strengthen the collaboration between surgical and mobile geriatric teams. Should the program have a substantial impact on the prevention of postoperative delirium in elderly, it could be extended to other facilities. Trial registration ClinicalTrials.gov: NCT01316965

Résumé: Contexte : La population âgée est plus vulnérable aux évènements indésirables iatrogènes notamment en raison de paramètres biologiques et physiologiques modifiés avec l'âge. Depuis les années 1990, différents outils ont été développés pour identifier les médicaments potentiellement inappropriés (MPI) chez le sujet âgé. Sur la base de ces outils, des interventions pharmaceutiques (IP) sont réalisées pour optimiser la prise en charge médicamenteuse du sujet âgé. Objectif : Évaluer l'impact clinique de la prescription des MPI chez le sujet âgé. Matériel et méthode : Une revue de la littérature a été effectuée en interrogeant la base de données PubMed sans restriction sur la date de publication des articles. Résultats : Au total, 37 études (18 cohortes prospectives, 17 cohortes rétrospectives et 2 études cas-témoin) ont été retenues. Vingt-sept études ont démontré un lien significatif entre l'exposition aux MPI et la survenue d'au moins un évènement clinique. À l'inverse, dix études n'ont rapporté aucun lien significatif. Les impacts cliniques associés à la prescription de MPI sont la survenue d'évènements indésirables iatrogènes, le passage aux urgences, le nombre d'hospitalisations, l'augmentation de la durée d'hospitalisation, la mortalité, la diminution de la qualité de vie liée à la santé, les fractures du col du fémur et les blessures consécutives à une chute. En revanche, 2 critères cliniques testés ne sont pas associés de façon significative à la prescription de MPI : le risque de chutes et l'altération de l'état général. Conclusion : La prescription de MPI chez le sujet âgé a un impact clinique. Background : The elderly population is more vulnerable to adverse drug events, particularly due to pharmacokinetic and pharmacodynamic changes. Since the 1990s, different tools have been developed to identify potentially inappropriate medication (PIM) in the elderly. Based on these tools, pharmaceutical interventions (IP) are performed to optimize the drug treatment of the elderly subject. Aim : Evaluate the clinical outcome of PIM prescribing in the elderly. Material and method : A systematic review was conducted using the database PubMed without restriction on the date of publication of articles. Results : Overall 37 studies were included in this review (18 prospective studies, 17 retrospective studies and 2 case-control studies). Twenty-seven studies demonstrated a significant association between exposure to PIM and the occurrence of at least one clinical event. Ten studies reported no significant link. The events associated with PIM prescribing are adverse drug events, emergency department visits, hospitalizations, prolonged hospital stay, mortality, health related quality of life, hip fractures and fall-related injuries. On the other hand, 2 clinical events are not significantly associated with PIM prescribing: the risk of falls and the functional status. Conclusion : PIM prescribing in elderly people is associated with clincal outcomes. [ABSTRACT FROM AUTHOR]

Résumé: De nombreux arguments sont en faveur du développement d'une prise en soin pharmaceutique chez le patient atteint de troubles neurocognitifs et chez son aidant : la polymédication, la iatrogénie cognitive, la non-adhésion médicamenteuse, la consommation accrue de psychotropes et de médicaments potentiellement inappropriés. L'objectif de cette revue narrative était d'identifier les différents rôles du pharmacien dans la prise en soin du patient atteint de maladie d'Alzheimer et maladies apparentées, et de son aidant. Dix-sept articles ont été sélectionnés après analyse de la littérature. Les différentes interventions décrites du pharmacien étaient les suivantes : la réalisation d'une revue de médication pouvant être ciblée sur la réduction de la charge anticholinergique et du nombre de psychotropes, l'éducation thérapeutique du patient et de son aidant concernant la gestion du traitement, la réalisation d'un suivi pharmaceutique personnalisé, le repérage et l'orientation des patients présentant une altération des performances cognitives ou des aidants présentant des signes de fragilité. La majorité des études identifiées ciblaient la prise en soin unique du patient. D'autres études interventionnelles seront nécessaires pour évaluer l'impact d'une prise en soin pharmaceutique de la dyade, y compris chez l'aidant, sur l'amélioration de la prise en charge médicamenteuse mais également sur des critères cliniques, notamment la fonction cognitive, l'autonomie, le recours au système de soins, la qualité de vie et l'auto-efficacité. Many arguments support the development of pharmaceutical care in patients with neurocognitive disorders and their caregivers: polypharmacy, drug-related cognitive decline, poor drug adherence, increased use of psychotropic drugs and potentially inappropriate medications. The aim of this narrative review was to identify the pharmacist's roles in caring for patients with Alzheimer's disease and related disorders and their caregivers. Seventeen publications were selected after literature research. The various interventions conducted by pharmacists were as follows: achievement of a medication review that could be focused on the reduction of the anticholinergic burden or the number of psychotropic drugs, therapeutic education of the patient and his caregiver concerning the treatment management, personalized pharmaceutical follow-up, screening and orientation of patients with a cognitive impairment or caregivers with signs of fragility (burden, anxiety or depressive symptoms). The majority of studies targeted the patient care. Other interventional studies will be necessary to evaluate the impact of a pharmaceutical care for the dyad, including the caregiver, on the improvement of drug management but also on clinical outcomes, including the cognitive function, the autonomy, the use of the health care system, the quality of life and the self-efficacy. [ABSTRACT FROM AUTHOR]

Background: Clinical pharmaceutical care has long played an important role in the improvement of healthcare safety. Pharmaceutical care is a collaborative care approach, implicating all the actors of the medication circuit in order to prevent and correct drug-related problems that can lead to adverse drug events. The collaborative pharmaceutical care performed during patients' hospitalization requires two mutually reinforcing activities: medication reconciliation and medication review. Until now, the impact of the association of these two activities has not been clearly studied.Methods: This is a multicentric stepped wedge randomized study involving six care units from six French University Hospitals (each unit corresponding to a cluster) over seven consecutive 14-day periods. Each hospital unit will start with a control period and switch to an experimental period after a randomized number of 14-day periods. Patients aged at least 65 years hospitalized in one of the participating care units and having given their consent to be called for a 30-day and 90-day follow-up can be enrolled. For each 14-day period, 15 patients will be recruited in each care unit to obtain a total of 630 patients enrolled in all centers. Patients with a hospital stay of more than 21 days will be excluded. During the control period, there will be no clinical pharmacist in the care unit, whereas during the experimental period a clinical pharmacist will perform medication reconciliation and review with the healthcare team. The primary outcome will assess the impact of collaborative pharmaceutical care on preventable medication error rate. The secondary outcomes will evaluate the clinical impact of the strategy, the acceptance rate of pharmaceutical interventions, the induced and avoided costs of the strategy (cost-consequence analysis), and the healthcare team's satisfaction.Discussion: This study will assess the impact of collaborative pharmaceutical care associating medication reconciliation and review at patient admission to hospital in terms of preventable medication error rate and costs. This activity will prevent and correct medication errors arising earlier in the hospitalization.Trial Registration: ClinicalTrials.gov, NCT02598115 . Registered on 4 November 2015. [ABSTRACT FROM AUTHOR]