[Implementation of a multi-interventional approach to improve medication safety in older hospitalized patients: Feasibility and impact on 30-day rehospitalization rate]

Abstract

Background: The impact of a multi-interventional approach for medication safety (MIMS) on rehospitalization rate have been inconstant in the literature. This would be due to difficulty in implementing the interventions and insufficient information transmission at discharge. The purpose of this study was to determine the effect of a MIMS on the 30-day rehospitalization rate after discharge from an acute geriatric unit (AGU).

Method: This was a single-center interventional randomized controlled trial that included patients hospitalized in an AGU and were at least 75 years old. The intervention group benefited from a MIMS including medication reconciliation at admission and at discharge, medication review, and standardized transmission of hospital's medication changes sent to community practitioners (general practitioners and pharmacists) at discharge. The control group benefited from the usual approach applied in the AGU.

Results: One hundred nine patients (mean age 87,5±6,1 years) were included. At intention-totreat analysis, the rehospitalization rate was 30% in the intervention group and 15,2% in the control group. The difference was non-significant before and after adjustments (P=0,27 and 0,28 respectively). However, the intervention protocol was not effectively completed in 40% of patients in the intervention group and no intervention was performed in 10%.

Conclusion: The implementation of a MIMS in an AGU showed a non-significant decrease in the number of rehospitalizations. Other indicators should be analysed, such as the reason for rehospitalisation or the maintenance of treatment at 30 days.

Keywords: Multiple-intervention strategy; Older patients; Patients âgés; Prescription; Procédure multi-interventionnelle; Rehospitalization; Ré hospitalisation.