JAMDA
Volume 13, Issue 4 , Pages 406.e1-406.e7, May 2012

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, MD, MPH, PhD

      Affiliations

    • Department of Internal Medicine, Rehabilitation and Geriatrics, Medical School and University Hospitals of Geneva, Geneva, Switzerland
    • EA3797, School of Medicine, University of Reims Champagne-Ardenne, Reims, France
    • Corresponding Author InformationAddress correspondence to Pierre Olivier Lang, MD, MPH, PhD, Hospital of Trois-Chêne, Department of Internal Medicine, Rehabilitation and Geriatrics, Chemin du Pont-Bochet 3, CH-1226 Thônex-Geneva, Switzerland.
    • ,
  • Nicole Vogt-Ferrier, MD

      Affiliations

    • Clinical Gerontopharmacology Unit, Department of Anesthesiology, Pharmacology and Intensive Care, Medical School and University Hospitals of Geneva, Geneva, Switzerland
    • ,
  • Yasmine Hasso, MD

      Affiliations

    • Department of Community Medicine and Primary Care, Medical School and University Hospitals of Geneva, Geneva, Switzerland
    • ,
  • Laurent Le Saint, MD

      Affiliations

    • Division of Psychiatry, Department of Neurosciences, Luxembourg Centre Hospital, Luxembourg
    • ,
  • Moustapha Dramé, MD, MPH, PhD

      Affiliations

    • EA3797, School of Medicine, University of Reims Champagne-Ardenne, Reims, France
    • ,
  • Dina Zekry, MD, PhD

      Affiliations

    • Department of Internal Medicine, Rehabilitation and Geriatrics, Medical School and University Hospitals of Geneva, Geneva, Switzerland
    • ,
  • Philippe Huber, MD

      Affiliations

    • Department of Internal Medicine, Rehabilitation and Geriatrics, Medical School and University Hospitals of Geneva, Geneva, Switzerland
    • ,
  • Christian Chamot

      Affiliations

    • Department of Internal Medicine, Rehabilitation and Geriatrics, Medical School and University Hospitals of Geneva, Geneva, Switzerland
    • ,
  • Pierre Gattelet

      Affiliations

    • Department of Internal Medicine, Rehabilitation and Geriatrics, Medical School and University Hospitals of Geneva, Geneva, Switzerland
    • ,
  • Max Prudent, MD, MPH

      Affiliations

    • EA3797, School of Medicine, University of Reims Champagne-Ardenne, Reims, France
    • ,
  • Gabriel Gold, MD

      Affiliations

    • Department of Internal Medicine, Rehabilitation and Geriatrics, Medical School and University Hospitals of Geneva, Geneva, Switzerland
    • ,
  • Jean Pierre Michel, MD

      Affiliations

    • Department of Internal Medicine, Rehabilitation and Geriatrics, Medical School and University Hospitals of Geneva, Geneva, Switzerland

published online 19 May 2011.

Abstract 

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.

Keywords: STOPP/START, inappropriate prescription, omission of prescription, prevention study, dementia, mental comorbidities

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 The study was supported by the Department of Rehabilitation and Geriatrics (DRG) of the University Hospitals of Geneva and the University and Medical School of Geneva (Switzerland). Sponsors did not have any role in the design, method, subject recruitment, data collection, analysis, or preparation of the manuscript.

PII: S1525-8610(11)00109-5

doi:10.1016/j.jamda.2011.03.008

JAMDA
Volume 13, Issue 4 , Pages 406.e1-406.e7, May 2012

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