Keywords: Medication review, elderly polymedicated patients, digital tools
Introduction:
The medication review (MR) aims to optimize the use of medications in polymedicated patients, by detecting interactions, adverse effects, misuse, overuse or underuse. In France MR is carried out by the community pharmacist in agreement with the general practitioner (GP). MR is paid to the pharmacist by French National Health Insurance. However very few MRs are carried out this way each year. The main obstacles declared by pharmacists are lack of time, insufficient skills in clinical pharmacy, and fear of tension with the GP or the patient.
MR can also be carried out in a primary care team during a quality meeting, or by a GP and a trainee during a supervision meeting, but again these are uncommon practices.
Method:
We designed ABIMED, a software that supports community pharmacists and GPs during MRs.
ABIMED analyzes the list of medications by taking into account the problems list and the patient's latest biological results contained in the electronic medical record.
ABIMED then provides a visual representation of dosage issues, side effects and drug interactions. ABIMED uses a drug database approved by the French National Health Agency.
ABIMED also suggests stopping or starting certain medications based on the 190 rules of STOPP/START v3.
We evaluated ABiMed with 39 pharmacists during a randomized simulation trial, each pharmacist performing a medication
review for two fictitious patients without ABiMed, and two others with ABiMed. Pharmacists’ medication reviews were compared to an expert-designed gold standard.
Results:
With ABiMed, pharmacists found 1.6 times more relevant drug-related problems during the medication review (p =
1.1 x10−12) and proposed better interventions (p = 9.8x10−9), without needing more time (p = 0.56). The System Usability Scale
score is 82.7, which is ranked “excellent”.
Conclusions:
Our main perspective is the validation of the system in clinical conditions.
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