Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France.
EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1, Oullins, France.
J Am Geriatr Soc. 2024 Feb;72(2):567-578. doi: 10.1111/jgs.18585. Epub 2023 Oct 11.
Hospital admission and discharge are at high risk of drug-related problems (DRPs) in older patients with cancer. This study aimed to assess the clinical and economic impact of a comprehensive pharmaceutical care intervention (RECAP) to optimize drug therapy in patients with cancer ≥75 years admitted to oncology or geriatric wards.
RECAP intervention was defined as follows: at admission and discharge, hospital pharmacists conducted comprehensive medication reconciliation and review, identified relevant DRPs and provided optimization recommendations to prescribers; at discharge, pharmacists also provided patient education and shared information with primary care providers. The impact of the intervention was assessed by the rate of implementation of recommendations by the prescribers and the evolution of polypharmacy rate; a peer review of the clinical significance of DRPs was performed by an expert panel of geriatric oncologists and pharmacists. A cost saving analysis compared cost avoided through resolution of DRPs to cost of pharmacist's time.
From January 2019 and August 2020, 201 patients were included (median age 80 [75-97] years), 68.7% with solid tumors. DRPs requiring optimization were identified in 70.9% of patients at admission (mean 1.7 DRP/patient) and 47.7% at discharge (0.9 DRP/patient). Most pharmacist recommendations (70.8%) were followed by prescribers, allowing the correction of 1.2 DRP/patient at admission and 0.7 DRP/patient at discharge. Half of resolved DRPs were rated as clinically significant. However, polypharmacy rate was not reduced at discharge. Cost comparison showed $7.2 avoided for $1 invested, with an estimated total net benefit of $354,822 (mean $1766 per patient).
The RECAP model significantly reduces DRPs in hospitalized older patients with cancer. The model was cost saving, confirming the value of implementing it in routine practice.
在老年癌症患者中，住院和出院期间存在较高的药物相关问题（DRP）风险。本研究旨在评估一项综合药物治疗管理干预措施（RECAP）对优化≥75 岁癌症住院患者药物治疗的临床和经济影响，这些患者被收入肿瘤或老年病房。
RECAP 干预措施定义如下：在入院和出院时，医院药剂师进行全面的药物重整和审查，识别相关的 DRP 并向开处方的医生提供优化建议；在出院时，药剂师还为患者提供教育并与初级保健提供者共享信息。干预措施的影响通过开处方医生建议的实施率和多药治疗率的演变来评估；老年肿瘤学家和药剂师专家组对 DRP 的临床意义进行了同行评议。通过解决 DRP 而避免的成本与药剂师时间成本进行成本节约分析。
从 2019 年 1 月至 2020 年 8 月，共纳入 201 例患者（中位年龄 80 [75-97] 岁），其中 68.7%为实体瘤患者。在入院时（平均 1.7 个 DRP/患者）和出院时（0.9 个 DRP/患者），分别有 70.9%和 47.7%的患者需要优化的 DRP。大多数药剂师的建议（70.8%）得到了开处方医生的采纳，使得入院时可以纠正 1.2 个 DRP/患者，出院时可以纠正 0.7 个 DRP/患者。一半解决的 DRP 被评为具有临床意义。然而，出院时多药治疗率并未降低。成本比较显示，每投入 1 美元可节省 7.2 美元，估计总净效益为 354822 美元（平均每位患者 1766 美元）。
RECAP 模型可显著减少老年癌症住院患者的 DRP。该模型具有成本效益，证实了在常规实践中实施该模型的价值。
