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Monitoring of Potentially Inappropriate Prescriptions in Older Inpatients: A French Multicenter Study
Author(s) -
PandraudRiguet Irène,
BonnetZamponi Dominique,
Bourcier Elsa,
Buyse Marion,
LaribeCaget Sandra,
Frémont Patrick,
Pautas Eric,
Verny Christiane,
Hindlet Patrick,
Fernandez Christine
Publication year - 2017
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15081
Subject(s) - medicine , observational study , medical prescription , pharmacist , geriatrics , prospective cohort study , beers criteria , pediatrics , pharmacy , family medicine , psychiatry , pharmacology
Objectives To determine whether potentially inappropriate medications ( PIM s) or potentially inappropriate associations ( PIA s) prescribed knowingly are associated with patient monitoring. Design Prospective observational study. Setting Geriatric units (n = 56) in 28 hospitals. Participants Inpatients aged 75 and older (N = 1,327). Measurements Potentially inappropriate prescriptions ( PIP ) were defined as a PIM or a PIA selected by an expert board from lists of explicit criteria (Beers, Priscus, Laroche, French Health Agency) using a Delphi process. They were considered to be prescribed knowingly if they were maintained after reassessment by the geriatrician and the clinical pharmacist. Primary outcome was the rate of PIP s maintained (prescribed knowingly) and for which a geriatrician declared that specific monitoring was performed. Secondary outcomes were the parameters monitored and the rate of participants receiving knowingly a PIP . Results One thousand sixty‐three PIP s were detected in 607 participants (46%). After reassessment, 826 (78%) PIP s were maintained in 490 participants (37%), the main reasons being participant's regular treatment and lack of alternative. Psychotropic (36%), cardiovascular (including antithrombotics) (29%), and laxative or antiemetic drugs (16%) were the most‐frequent classes prescribed knowingly. The geriatricians declared to perform clinical or biological monitoring for 69% (n = 570) of PIM s or PIA s prescribed knowingly. Three types of specific monitoring were identified: clinical, biological, and follow‐up with a specialist. Conclusion Approximately three‐quarters of PIM s or PIA s were prescribed knowingly, of which 69% were monitored, with wide variations in occurrence and in quality according to drug classes. This underlines the need for accurate guidelines on PIP monitoring.