Conciliation des traitements médicamenteux en gériatrie : Pertinence et faisabilité

Résumé Objectif : Cette etude a pour but de detecter, par la conciliation des traitements medicamenteux, les erreurs medicamenteuses et d’evaluer la pertinence et la faisabilite de cette pratique standardisee au sein du departement de geriatrie aigue de l’hopital. Mise en contexte : De nombreuses erreurs medicamenteuses surviennent lors de la transition communaute/hopital, particulierement parmi les patients ages. Afin de les reduire et de garantir au patient un parcours de sante de qualite et securise, la France participe au projet international ≪ SOP MED’REC ≫, lance par l’Organisation mondiale de la Sante et destine a mettre en oeuvre la conciliation des traitements medicamenteux. Résultats : Quarante-cinq patients (45) ont ete inclus dans l’etude sur une periode de trois mois. Neuf divergences non intentionnelles ont ete recueillies, dont un ajout, cinq omissions et trois modifications de posologie. Deux cent trentedeux (232) divergences intentionnelles ont ete repertoriees, dont 65 documentees et 167 non documentees. A la sortie de l’hopital, les traitements de 25 patients ont ete concilies et 32 divergences ont ete detectees. La duree totale de la conciliation medicamenteuse, de l’admission au depart, est estimee a 70 minutes par patient. Discussion : La conciliation medicamenteuse necessite une amelioration de la collaboration entre les differents acteurs du parcours de soins du patient : medecins traitants, medecins hospitaliers, pharmaciens hospitaliers et pharmaciens d’officine. Cependant, ce processus a permis de deceler et de corriger des erreurs medicamenteuses, plus frequemment retrouvees a la sortie qu’a l’admission. En revanche, les nombreuses divergences intentionnelles non documentees sont un point a ameliorer, car un defaut de tracabilite peut generer des erreurs medicamenteuses. Conclusion : La conciliation des traitements medicamenteux en geriatrie securise la prise en charge medicamenteuse des patients et participe a la culture de qualite de l’etablissement. Abstract Objective: The purpose of this study was to detect medication errors through medication reconciliation and to assess the usefulness and feasibility of this standardized practice in an acute geriatric unit. Background: Many medication errors occur during the community-hospital transition, especially in elderly patients. To reduce the number of such errors and ensure patients a quality and safe care trajectory, France is participating in the international project SOP MED’REC, launched by the World Health Organization and aimed at the implementation of medication reconciliation. Results: Forty-five patients (45) were included in the study over a 3-month period. Nine unintentional discrepancies were found: one addition, five omissions and three dosage modifications. Two hundred and thirty-two (232) intentional discrepancies were identified. Of them, 65 were documented and 167 were undocumented. At discharge from the hospital, 25 patients’ medications were reconciled, which revealed 32 discrepancies. The total duration of medication reconciliation, from admission to discharge, is estimated at 70 minutes per patient. Discussion: Medication reconciliation requires better cooperation between the different players in the patient care trajectory: personal physicians, hospital physicians, hospital pharmacists and community pharmacists. This exercise resulted in the detection and correction of medication errors, which were found more frequently during discharge than admission. The large number of undocumented intentional discrepancies needs to be addressed, since a lack of traceability can lead to medication errors. Conclusion: Medication reconciliation in geriatrics makes for safe pharmacological patient management and contributes to the institution’s quality culture. Key words: Intentional discrepancies, geriatrics, medication errors, medication reconciliation, unintentional discrepancie

Sex Differences in Medicine Acceptability: A New Factor to Be Considered in Medicine Formulation

International audiencePalatability is a recognized driver of medicine acceptability in pediatrics but deemed less relevant in older populations due to sensory decline. Preliminary findings from an observational study implicated palatability problems with one Alzheimer's medicine. Among 1517 observer reports combining multiple measures on medicines uses in patients aged over 64, we focused on two original formulations of memantine (Ebixa (R), tablets (n = 25) and oral solution (n = 60)). Evaluations were scored with an acceptability reference framework (CAST), the rodent Brief Access Taste Aversion (BATA) model tested aversiveness. Focusing on women treated with Ebixa (R) (n = 54), the oral formulation sub-group was classified as negatively accepted, while the coated tablet was associated with the positively accepted cluster. In men, both formulations belonged to the positively accepted profile. Using BATA, the original oral solution was categorized as highly aversive/untolerated while solutions of excipients only were well tolerated. Furthermore, the number of licks was significantly lower in female than in male rats. These results revealed that medicine palatability remains important for acceptability in older populations. Moreover, converging results from humans and animal models highlighted that palatability profiles can significantly vary between the sexes. These drivers should be closely considered during drug development to enhance acceptability in this population

A Decision Support Tool Facilitating Medicine Design for Optimal Acceptability in The Older Population

International audiencePurposeMedicine acceptability, which is of the utmost importance for vulnerable patients’ adherence, is driven by both user and product characteristics. Herein, a novel multivariate approach integrating the many aspects of acceptability is used to discriminate positively and negatively accepted medicines in the older population.MethodsAn observational study was carried out in eight hospitals and eight nursing homes to collect a large set of real-life data on medicines uses in older patients (≥65 years). Mapping and clustering explored these multiple observational measures and summarised the main information into an intelligible reference framework. Resampling statistics were used to validate the model’s reliability.ResultsA three-dimensional map and two clusters defining acceptability profiles, as positive or negative, emerged from the 1079 evaluations. Factors of interest (medicines, user features…) were positioned on the map at the barycentre of their evaluations and assigned to an acceptability profile. Focusing on patients’ ability to swallow, we have highlighted the tool’s efficacy in demonstrating the impact of user features on medicine acceptability.ConclusionsThis multivariate approach provides a relevant judgement criterion for this multi-dimensional concept. Facilitating the choice of the most appropriate dosage form to achieve optimal acceptability in a targeted population, this tool is of real potential to improve clinical decisions