Home Improvement Initiative of the TRaitement Optimisé Medicamenteux After Hospitalization

Home Improvement Initiative of the TRaitement Optimisé Medicamenteux After Hospitalization

The hypothesis is that the intervention of an operational clinical pharmacy team (EOPC), targeting both patients and hospital and health care professionals, allows: i) to initiate a therapeutic review during hospitalization, ii) to accompany the patients upon hospital discharge, iii) to maintain, in outpatient care, the drug treatments that have been optimized during hospitalization.

The main objective of the study is to demonstrate that the intervention of an EOPC in surgical departments and then in outpatient care makes it possible to maintain, 45 days after the discharge of the patients aged 65 years and over, the chronic outpatient treatments revised and optimized during the hospital stay.

The secondary objectives are to measure the impacts of EOPC's intervention on:

• unexpected readmissions, emergency use, medical complications and adverse drug reactions;
• patient and health professional satisfactions (community pharmacists and physicians);
• the costs of drug treatments in ambulatory care.

Inclusion Criteria:

• Patient (man or woman)
• age ≥ 65 years with more than 3 drugs taken for 3 months, stay in surgery with a duration of ≥ 1 days including urgent surgery;
• affiliated to a social health insurance scheme;
• for whom a return home is possible;
• able to understand the objectives of the research and give informed, dated and signed consent.

Exclusion Criteria:

• Patient (man or woman)
• with as a hospital discharge an entry into a nursing home or long-term care called "important medical and technical care (SMTI);
• with cognitive or other problems preventing consent (at the discretion of the geriatric expertise team);
• under the safeguard of justice;
• under tutorship or curatorship.