Orthogeriatric treatment reduces potential inappropriate medication in older trauma patients: a retrospective, dual-center study comparing conventional trauma care and co-managed treatment.
Frailty
Hip fracture
Humeral fracture
Integrated care
Pharmacotherapy
Journal
European journal of medical research
ISSN: 2047-783X
Titre abrégé: Eur J Med Res
Pays: England
ID NLM: 9517857
Informations de publication
Date de publication:
22 Jan 2019
22 Jan 2019
Historique:
received:
16
11
2018
accepted:
12
01
2019
entrez:
24
1
2019
pubmed:
24
1
2019
medline:
22
5
2019
Statut:
epublish
Résumé
Multimorbidity and polypharmacy are common challenges in the treatment of older trauma patients. Therefore, various integrated care models were developed over the last few years, merging the expertise of geriatricians and trauma surgeons. The aim of this study was to evaluate, if the number of prescriptions of potentially inappropriate medication (PIM) could be reduced in these patients by an interdisciplinary co-managed concept compared to conventional trauma care. We conducted a retrospective, dual-center cohort study, including all patients aged 70 years and older admitted with a fracture of the hip or the proximal humerus within the study period. Patients were treated in the universities department of trauma surgery with two different hospital sites, one with conventional trauma care (CTC) and the other one with a certified orthogeriatric trauma unit (OGC). Based on the STOPP/START criteria by O´Mahony et al., PIMs were defined, which should be avoided in (ortho)geriatric patients. Medical records of each patient were analyzed at discharge. Besides patients basic information, all prescribed drugs, changes in the medication plan and who carried out these changes were collected. For statistical analysis based on the data quality and distribution, the t test, Mann-Whitney U test and the Chi-square test were used. A total of 95 patients were included, 73 of them females, with an average age of 82.59 years (SD ± 6.96). Mean length of hospital stay was 12.98 at CTC and 13.36 days at OGC (p = 0.536). Among conventional care (41 patients), prescription of one or more PIMs was found in 85.4% of the patients, whereas at the orthogeriatric ward (54 patients) only in 22.2% (p < 0.001). Besides that, changes in medication were made for 48.1% of the patients during their stay on the orthogeriatric ward. Our findings show that an integrated care concept can reduce the number of prescriptions of PIMs significantly and potentially avoids adverse drug reactions and additional burdens in older trauma patients.
Sections du résumé
BACKGROUND
BACKGROUND
Multimorbidity and polypharmacy are common challenges in the treatment of older trauma patients. Therefore, various integrated care models were developed over the last few years, merging the expertise of geriatricians and trauma surgeons. The aim of this study was to evaluate, if the number of prescriptions of potentially inappropriate medication (PIM) could be reduced in these patients by an interdisciplinary co-managed concept compared to conventional trauma care.
METHODS
METHODS
We conducted a retrospective, dual-center cohort study, including all patients aged 70 years and older admitted with a fracture of the hip or the proximal humerus within the study period. Patients were treated in the universities department of trauma surgery with two different hospital sites, one with conventional trauma care (CTC) and the other one with a certified orthogeriatric trauma unit (OGC). Based on the STOPP/START criteria by O´Mahony et al., PIMs were defined, which should be avoided in (ortho)geriatric patients. Medical records of each patient were analyzed at discharge. Besides patients basic information, all prescribed drugs, changes in the medication plan and who carried out these changes were collected. For statistical analysis based on the data quality and distribution, the t test, Mann-Whitney U test and the Chi-square test were used.
RESULTS
RESULTS
A total of 95 patients were included, 73 of them females, with an average age of 82.59 years (SD ± 6.96). Mean length of hospital stay was 12.98 at CTC and 13.36 days at OGC (p = 0.536). Among conventional care (41 patients), prescription of one or more PIMs was found in 85.4% of the patients, whereas at the orthogeriatric ward (54 patients) only in 22.2% (p < 0.001). Besides that, changes in medication were made for 48.1% of the patients during their stay on the orthogeriatric ward.
CONCLUSIONS
CONCLUSIONS
Our findings show that an integrated care concept can reduce the number of prescriptions of PIMs significantly and potentially avoids adverse drug reactions and additional burdens in older trauma patients.
Identifiants
pubmed: 30670088
doi: 10.1186/s40001-019-0362-0
pii: 10.1186/s40001-019-0362-0
pmc: PMC6341562
doi:
Types de publication
Comparative Study
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
4Références
Aging Clin Exp Res. 2008 Apr;20(2):113-22
pubmed: 18431078
J Bone Miner Res. 2009 Jul;24(7):1299-307
pubmed: 19257816
Drugs Aging. 2010 Aug 1;27(8):653-61
pubmed: 20658793
Dtsch Arztebl Int. 2010 Aug;107(31-32):543-51
pubmed: 20827352
Osteoporos Int. 2010 Dec;21(Suppl 4):S637-46
pubmed: 21058004
Injury. 2012 Jun;43(6):676-85
pubmed: 21683355
J Am Geriatr Soc. 2011 Nov;59(11):2139-44
pubmed: 21883113
J Orthop Trauma. 2013 Dec;27(12):672-6
pubmed: 23515124
Gerontology. 2014;60(2):114-22
pubmed: 24246485
J Pharmacol Pharmacother. 2013 Dec;4(Suppl 1):S104-9
pubmed: 24347974
Unfallchirurg. 2015 Sep;118(9):780-94
pubmed: 24352202
Curr Drug Saf. 2014;9(2):89-105
pubmed: 24410307
BMC Geriatr. 2014 Mar 27;14:40
pubmed: 24674152
Clin Geriatr Med. 2014 May;30(2):175-81
pubmed: 24721358
Age Ageing. 2015 Mar;44(2):213-8
pubmed: 25324330
Clin Gastroenterol Hepatol. 2015 May;13(5):906-12.e2
pubmed: 25460554
BMC Geriatr. 2014 Dec 04;14:131
pubmed: 25475854
Ir J Med Sci. 2017 Feb;186(1):179-184
pubmed: 27059996
Clin Interv Aging. 2016 Apr 29;11:489-96
pubmed: 27199553
Osteoporos Int. 2017 Jan;28(1):269-277
pubmed: 27443570
Eur J Trauma Emerg Surg. 2016 Oct;42(5):559-564
pubmed: 27458065
BMJ Qual Improv Rep. 2014 Sep 19;3(1):null
pubmed: 27493729
Shoulder Elbow. 2014 Apr;6(2):95-9
pubmed: 27582921
Geriatr Orthop Surg Rehabil. 2017 Jun;8(2):109-114
pubmed: 28540117
Drugs Aging. 2017 Sep;34(9):723-728
pubmed: 28776209
Curr Orthop Pract. 2017 Nov;28(6):580-585
pubmed: 29177024
Age Ageing. 2018 May 1;47(3):489
pubmed: 29182733
Clin Epidemiol. 2018 Mar 12;10:289-298
pubmed: 29559811
Intern Med J. 2018 Oct;48(10):1192-1197
pubmed: 29740921
J Clin Pharmacol. 2019 Jan;59(1):55-73
pubmed: 30204233