Interdisciplinary geriatric and psychiatric care reduces potentially inappropriate prescribing in the hospital: interventional study in 150 acutely ill elderly patients with mental and somatic comorbid conditions

Pierre Olivier Lang, Nicole Vogt-Ferrier, Yasmine Hasso, Laurent Le Saint, Moustapha Dramé, Dina Zekry, Philippe Huber, Christian Chamot, Pierre Gattelet, Max Prudent, Gabriel Gold, Jean Pierre Michel
Journal of the American Medical Directors Association 2012, 13 (4): 406.e1-7

BACKGROUND: Potentially inappropriate medications and prescription omissions (PO) are highly prevalent in older patients with mental comorbidities.

OBJECTIVE: To evaluate the effect of interdisciplinary geriatric and psychiatric care on the appropriateness of prescribing.

DESIGN: Prospective and interventional study.

SETTING: Medical-psychiatric unit in an academic geriatric department.

PARTICIPANTS: Participants were 150 consecutive acutely ill patients aged on average 80.0 ± 8.1 years suffering from mental comorbidities and hospitalized for any acute somatic condition.

INTERVENTION: From admission to discharge, daily collaboration provided by senior geriatrician and psychiatrist working in a usual geriatric interdisciplinary care team.

MEASUREMENTS: Potentially inappropriate medications and PO were detected and recorded by a trained independent investigator using STOPP/START criteria at admission and discharge.

RESULTS: Compared with admission, the intervention reduced the total number of medications prescribed at discharge from 1347 to 790 (P < .0001) and incidence rates for potentially inappropriate medications and PO reduced from 77% to 19% (P < .0001) and from 65% to 11% (P < .0001), respectively. Independent predictive factors for PIP at discharge were being a faller (odds ratio [OR] 1.85; 95% confidence interval [CI] 1.43-2.09) and for PO, the increased number of medications (OR 1.54; 95% CI 1.13-1.89) and a Charlson comorbidity index greater than 2 (OR 1.85; 95% CI 1.38 - 2.13). Dementia and/or presence of psychiatric comorbidities were predictive factors for both potentially inappropriate medications and PO at discharge.

CONCLUSION: These findings hold substantial promise for the prevention of IP and OP in such a comorbid and polymedicated population. Further evaluations are, however, still needed to determine if such an intervention reduces potentially inappropriate prescribing medication-related outcomes, such as incidence of adverse drug events, rehospitalization, or mortality.

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