Background A medicinal treatment optimisation (MTO) programme has been implemented since 2012 in a gerontological sector (GS) of our territory.
Purpose Measure the degree of involvement of the Establishments for Elderly Dependent Persons (EEDP) in this programme.
Material and methods A first audit evaluating each stage of the medication circuit (from prescription to drugs administration) was carried out between 2012 and 2014 in every EEDP of the GS (38 institutions). Then, individualised and specific improvement actions (IA) have been defined for each EEDP in a multidisciplinary way. Finally, since 2015, a second audit is carried out in each EEDP, with the same analysis criteria of the first audit. We presents here first comparison results (only from the EEDP that benefited from this second audit): on the one hand, we measured the rate of implementation of IA in every EEDP, and on the other we compared specific prescription indicators before and after implementation of these IA.
Results These first results concern 47% of the EEDP of the GS (18/38). For these 18 EEDP, 250 IA were defined after the first audit, with an average of 13.9 IA per EEDP (min: 9, max: 22). After the second audit, we observed that 189 IA (75.6%) had been implemented partially or totally (average: 10.5IA/15 per EEDP). Concerning prescriptions’ indicators, the number of medications per prescription decreased from 7.5 on average per EHPAD after the first audit (min: 4.2, max: 14) to 5.5 after the second (min: 4, max: 8.1). A recent renal clearance (less than 1 year) was found in 63% of residents records after the first audit (min: 20%, max: 96%) and in 85% of residents records after the second (min: 63.3%, max: 100%).
Conclusion The impact of our MTO programme appears to be positive, although these results have to be confirmed in other EEDP of the GS. One of the often-proposed IA for improving drug prescriptions in the elderly was the implementation of multidisciplinary proofreading sessions of prescriptions within the EEDP, with the participation of general practitioners. In the end, we observed a decrease of two drugs per prescription, and an increase of 20% in renal clearance measures.
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