Potentially Inappropriate Drug Prescribing in French Nursing Home Residents: An Observational Study.

Purpose: To identify the prevalence of potentially inappropriate drug prescription in a sample of nursing home residents in France, combining explicit criteria and implicit approach and to involve pharmacists in the multi-professional process of therapeutic optimization. Methods: A cross-sectional, observational, multicenter study was conducted during a five-month period in a sample of French nursing homes. Information on drug prescription, diseases, and socio-demographic characteristics of nursing home residents was collected. For each prescription, identification of potentially inappropriate drug prescription was done, based on explicit and implicit criteria. Results: Nursing home residents were administered an average of 8.1 (SD 3.2, range 0-20) drugs per day. Nearly 87% (n = 237) of the residents had polypharmacy with five or more drugs prescribed per day. Among the 274 nursing home residents recruited from five nursing homes, 212 (77.4%) had at least one potentially inappropriate drug prescription. According to the Laroche list, 84 residents (30.7%) had at least one drug with an unfavorable benefit-harm balance. An overdosing was found for 20.1% (n = 55) of the residents. Nearly 30% (n = 82) of the residents had a drug prescribed without valid medical indication. Conclusions: This study shows that potentially inappropriate drug prescriptions are highly prevalent among nursing home residents, nevertheless pharmacists can take part in drug utilization review in collaboration with the nursing home staff.

Factors predisposing nursing home resident to inappropriate transfer to emergency department. The FINE study protocol.

BACKGROUND: Each year, around one out of two nursing home (NH) residents are hospitalized in France, and about half to the emergency department (ED). These transfers are frequently inappropriate. This paper describes the protocol of the FINE study. The first aim of this study is to identify the factors associated with inappropriate transfers to ED. METHODS/DESIGN: FINE is a case-control observational study. Sixteen hospitals participate. Inclusion period lasts 7 days per season in each center for a total period of inclusion of one year. All the NH residents admitted in ED during these periods are included. Data are collected in 4 times: before transfer in the NH, at the ED, in hospital wards in case of patient's hospitalization and at the patient's return to NH. The appropriateness of ED transfers (i.e. case versus control NH residents) is determined by a multidisciplinary team of experts. RESULTS: Our primary objective is to determine the factors predisposing NH residents to inappropriate transfer to ED. Our secondary objectives are to assess the cost of the transfers to ED; study the evolution of NH residents' functional status and the psychotropic and inappropriate drugs prescription between before and after the transfer; calculate the prevalence of potentially avoidable transfers to ED; and identify the factors predisposing NH residents to potentially avoidable transfer to ED. DISCUSSION: A better understanding of the determinant factors of inappropriate transfers to ED of NH residents may lead to proposals of recommendations of better practice in NH and would allow implementing quality improvement programs in the health organization.

[Medical and social management of homeless individuals. A one year prospective observational study in the south part of France, Pyrénées-Orientales]. / Prise en charge médico-sociale de personnes sans domicile fixe: etude observationnelle prospective d'un an dans les Pyrénées-Orientales.

In 2007, a national survey estimated to up to 800,000 the number of homeless individuals in France. Ten percent of them live constantly in the street; often very dissocialized and in precarious conditions. Thereby it remains difficult for homeless to have access to a medical and social support. In order to identify the medical and social needs of this population, we performed a one year observational prospective study in two reception centres in Perpignan. 629 (99%) out of 635 answers were analysed. The most represented age group is 39-49 years (29,2%) with an over-representation of males (82,7%). The most frequent pathologies are psychological distress (43,9% of requests, including anxious problems 23%, and sleep disturbances 24,4%). Medical affections represented 15,7% of the cases (mainly nutritional deficiency), and skin diseases 15,%. Addictive behaviour was frequent including tobacco (84%), alcohol (17%), and drug addiction (9%). 21,7% of this population had a regular work, and 97,8% with fixed term contracts, but 45,1% did not have any health cover 17,6% of homeless did not obtain any answer to their medical request (lack of suitable medicine, or an impossibility to pull out further tests in order). To solve some aspects of that problem, family doctor can rely on a medical and social network (PASS, MAO, ANPAA).

Effectiveness of drug tests in outpatients starting opioid substitution therapy.

We aimed to assess the effectiveness of drug tests for treatment retention in outpatients starting opioid substitution therapy. A retrospective cohort was created from the data of the French health insurance system database for the Midi-Pyrenees region. Patients starting opioid substitution treatment (OST) were included and followed for 18 to 30 months. Two groups of patients were defined: the drug test group (at least one drug test reimbursement) and a control group (no drug test reimbursement). The cohort included 1507 patients. During follow-up, 39 subjects (2.6%) had at least one drug test reimbursement. Mean treatment retention was 207 days in the control group and 411 days in the drug test group (p < 0.001). With a multivariate Cox model, drug tests were associated with treatment retention: hazard ratio 0.55 (95% CI: 0.38-0.80). Use of a drug test in follow-up of opioid substitution treatment, although rarely prescribed, significantly improved treatment retention.

On-site drugs of abuse urinary screening tests for the management of opiate-addicted patients: a survey among French general practitioners.

In France, opiate-addicted patients are mainly managed by general practitioners (GPs). Because on-site abuse drugs urinary screening tests (ODUTs) are now on the market, we investigated French GPs' knowledge and practices concerning drug tests with a focus on ODUTs. We conducted a descriptive cross-sectional study in ambulatory practice. Postal questionnaires were sent to a random sample of GPs in the Midi-Pyrénées area of France in December 2009. Of the 482 GPs in the sample, 116 (24.1%) regularly treated opiate- addicted patients. Only 31 of them (26.7%) used drug tests and 4 of them (3.4%) performed ODUTs in their consultation rooms. Most of the GPs did not perform ODUTs because they were unaware of whether such tests were reliable or available. Many French GPs treating opiate-addicted patients regularly did not perform ODUTs and lacked knowledge of them.

[Which analgesic after dextropropoxyphene withdrawal? A survey in a sample of general practitioners in southwest of France]. / Quel(s) antalgique(s) après le retrait du dextropropoxyphène ? Enquête auprès de médecins généralistes de la région Midi-Pyrénées.

Following the announcement of the future withdrawal in Europe of drugs containing dextropropoxyphene-paracetamol (DXP-P), we performed a postal survey in a randomly selected sample of 350 general practitioners (GP) from the Midi-Pyrénées area (2.6 million inhabitants) in order to investigate which drug (s) they are willing to prescribe in anticipation of the announced withdrawal. Most of GP prescribed DXP-P in acute and chronic pain. In acute pain, GP would switch to codeine-paracetamol (59.1%) or tramadol alone or associated with paracetamol (79%), whereas they would switch to high dose paracetamol (54.7%) and tramadol alone or associated with paracetamol (74.6%) in chronic pain. Switching to other level 2 analgesic drugs after the withdrawal of dextropropoxyphene should be closely monitored because the safety profile of other drugs.

[Prescription of drugs with ASMR V in patients over 65 years in a primary care ambulatory setting. Drug prescription analysis in the Midi-Pyrénées region (France)]. / Prescription de médicaments ASMR de niveau V chez les sujets de plus de 65 ans en soins primaires ambulatoires. Analyse d'ordonnances en région Midi-Pyrénées.

UNLABELLED: In French patients over 65 years, drug intake is characterized by polytherapy, causing iatrogenic events. The general practitioner is the main actor in the follow-up and reassessment of drug prescriptions. OBJECTIVE: To assess the proportion of ASMR V (Amélioration du service medical rendu - additional therapeutic benefit versus current standards) drugs [drugs producing no medical improvement] prescribed to patients over 65 years in the management of a chronic disease. MATERIAL AND METHOD: In May 2009, 849 drug prescriptions were collected from 34 general practitioners in the Midi-Pyrénées region. Specialties with ASMR V were classified according to the anatomical therapeutic chemical (ATC) classification system. RESULTS: 58.8% of the prescriptions concerned female patients; 67.4% of the prescriptions contained at least one ASMR-V drug. Approximately 20% of the prescriptions in subjects over 65 years contained ASMR-V drugs. DISCUSSION: This study shows that older subjects are being prescribed a significant number of ASMR-V drugs. However, this classification combines several situations, including a product line extension, a fixed combination of preexisting drugs, an insufficient therapeutic benefit, the absence of additional therapeutic benefit versus a comparative drug, the absence of comparative study in some indications, or a less favorable benefit-risk ratio comparing to that of the reference drug.This classification includes as well the generic drugs prescribed using the international non proprietary names. This study did not analyze the influence of certain factors, such as treatment history, history of drug allergy or dose titration, which could influence the physician's decision. CONCLUSION: Following this study, it appears useful to extend this type of survey to other general practitioners in other French regions, and to analyze the reasons for prescribing ASMR-V drugs. These data would help increasing general practitioners' awareness of "proper drug use" to reduce the proportion of "inadequate" drugs prescribed to older subjects. One could also consider conducting a survey amongst older patients under polytherapy, to question them on the treatments taken.