Association Between Geriatric Frailty and Medication Related Problems in the Emergency Department to Help Clinical Pharmacists Prioritise Patients

Официальное название

DETECTION OF ISAR-FLAGGED AT-RISK MEDICATION IN THE EMERGENCY DEPARTMENT (DISARMED)

Обзор

The healthcare systems are under increasing pressure due to a rise in emergency consultations, staff shortages, an ageing population and rising costs. Emergency departments are seeing more vulnerable patients, including elderly people, who are often on multiple medications and at risk of medication errors. To improve safety, the integration of pharmacists specialising in emergency medicine has proven beneficial: their presence in the team improves the detection of medication-related problems, speeds up and optimises treatment, reduces rehospitalisations and lowers healthcare costs. However, in most countries, these pharmacists are still rarely found in emergency departments, mainly due to a lack of resources and clinical prioritisation criteria tailored for them and adapted to this environment. Frailty screening tools and scores, such as ISAR, can be used to identify the elderly patients most at risk, predict adverse events such as fall or mortality, and thus adapt their care in the emergency department. Indeed, elderly frail patients often take many medications and consequently are at risk of medication errors, adverse events, inappropriate prescriptions or serious drug interactions. These patients may therefore require a specialised review on their medication by clinical pharmacists when they are admitted to the emergency department, but their high number make it impossible to care for all of them. We aim thus to evaluate the association between frailty (according to the ISAR score) and medication-related problems among elderly patients admitted to the emergency department. Researchers will examine whether this score can predict the presence of inappropriate prescribing and high-risk drug interactions. If so, pharmacists would then have a quick and easy tool to prioritise patients who would benefit most from a specialised review of their medications when they visit the emergency department. There will not be any intervention and this study will not influence patients care. Once patients agree to participate, researchers will prospectively collect medical data from elderly patients admitted to the emergency department and analyse their medical history, home medication, reason for admission, frailty score using ISAR, and perform a pharmaceutical analysis based on these data.

Вмешательства

• Другое Pharmaceutical analysis based on the Electronic Patient Record
  After inclusion, each patient's data will be collected and analysed by the investigator in the following 5 days. The said data will be: * Independent variables (demographic data, laboratory results, comorbidities, home medication treatment, reason for admission) * The ISAR score, using the electronic patients record * The number of inappropriate prescriptions, using STOPP/START version 3 online tool. * The number of high-risk drug interactions (categories D "Consider therapy modification" and X

Первичные конечные точки

• The rate of inappropriate prescription (PIP) as a function of their ISAR score. [Срок оценки: At the time of their admission to the emergency department]
• The rate of high-risk drug-drug interactions (DDIs) as a function of their ISAR score. [Срок оценки: At the time of their admission to the emergency department]

Вторичные конечные точки (1)

• The predictive performance of the ISAR score for the detection of PIPs and high-risk DDIs. [Срок оценки: At the time of their admission to the emergency department.]

Критерии участия

Критерии включения

• Patients aged ≥ 75 years admitted to the adult emergency department
• Patients able to give informed consent as documented by signature or a therapeutic representative, if applicable .

Критерии исключения

• Patients initially admitted to the emergency resuscitation room.
• Patients admitted to the minor accidents and emergencies room.
• Patients admitted to the stroke unit, as they just pass through the emergency department to directly proceed to the CT-scanner.
• Missing data for proper file analysis (e.g., missing usual home medication)
• Patient's inability to sign consent and no therapeutic representative available
• Patient's refusal to sign consent
• Emergency physician's refusal to include patient for any reason.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Дизайн исследования

Модель наблюдения

Когортное

Центры проведения

Швейцария · 1 центр

• Hôpital Riviera-Chablais (Vaud-Valais), service des urgences — Rennaz

Публикации

• Kempen TGH, Hedstrom M, Olsson H, Johansson A, Ottosson S, Al-Sammak Y, Gillespie U. Assessment tool for hospital admissions related to medications: development and validation in older patients. Int J Clin Pharm. 2019 Feb;41(1):198-206. doi: 10.1007/s11096-018-0768-8. Epub 2018 Dec 26. PMID 30585296
• Abuzour AS, Hoad-Reddick G, Shahid M, Steinke DT, Tully MP, Williams SD, Lewis PJ. Patient prioritisation for hospital pharmacy services: current approaches in the UK. Eur J Hosp Pharm. 2021 Nov;28(Suppl 2):e102-e108. doi: 10.1136/ejhpharm-2020-002365. Epub 2020 Dec 1. PMID 33262131
• McCusker J, Bellavance F, Cardin S, Trepanier S, Verdon J, Ardman O. Detection of older people at increased risk of adverse health outcomes after an emergency visit: the ISAR screening tool. J Am Geriatr Soc. 1999 Oct;47(10):1229-37. doi: 10.1111/j.1532-5415.1999.tb05204.x. PMID 10522957
• Ellis B, Carpenter CR, Lowthian JA, Mooijaart SP, Nickel CH, Melady D. Statement on Minimum Standards for the Care of Older People in Emergency Departments by the Geriatric Emergency Medicine Special Interest Group of the International Federation for Emergency Medicine. CJEM. 2018 May;20(3):368-369. doi: 10.1017/cem.2017.426. Epub 2018 Jan 23. No abstract available. PMID 29357950
• Almarsdottir AB, Haq R, Norgaard JDSV. Prioritizing patients for medication review by emergency department pharmacists: a multi-method study. Int J Clin Pharm. 2023 Apr;45(2):387-396. doi: 10.1007/s11096-022-01515-3. Epub 2022 Dec 5. PMID 36469215
• Bamps J, Lelubre S, Cauchies AS, Devillez A, Almpanis C, Patris S. Identification of seniors at risk (ISAR) score and potentially inappropriate prescribing: a retrospective cohort study. Int J Clin Pharm. 2024 Dec;46(6):1345-1351. doi: 10.1007/s11096-024-01766-2. Epub 2024 Jul 2. PMID 38954078

Идентификаторы

NCT: NCT07282379 · DISARMED2026

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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