RESULTS
Between January 27 and April 30, 2020, 355 stays were analysed by the clinical pharmacists team, 166 (46.8%) prior to COVID-19 and 189 (53.2%) during the first wave of COVID-19 (mean±SD age 88.0±5.7y; 59.4% female; AGGIR score 3.2±1.2); mean number of line of treatment validated 12.4±7.8; mean length of stay 10.2±6.7 days; death rate 10.4%).
There were no significant differences in the demographical measures of the population. During COVID-19 the mean length of stay was shorter (p<0.05) and the mean number of line of treatment per patient was larger (p<0.05). Characteristics of the stays analysed by the clinical pharmacists are detailed in Table 1.
The pharmacists analysed and validated 4,402 line of treatment (1,436 before the COVID and 2,966 during the pandemic). Among them 231 PIs were carried out (5.2%): 54 for prescriptions prior to the COVID-19 (23.4%) and 177 during the COVID-19 (76.6%). There were significantly more PIs per line of treatment validated during the pandemic (p=0.002).
Prior to COVID-19, PIs were generated for 21.7% (n=36) of the stays; the rate of PIs per stay analysed was 0.33. During the first wave of COVID-19, PIs were generated for 53.4% (n=101) of the stays; the rate of PIs per stay analysed was 0.94. There were significantly more PIs per patient during the pandemic (p=1.029 E-9).
The distribution of the PIs according to the therapeutic classes is detailed in Table 2.
Prior to COVID-19, the therapeutic classes with most PIs were laxatives (n=7; 13.0%), proton pump inhibitor (n=6; 11.1%) and acetaminophen (n=6; 11.1%). There were significantly more PIs on laxatives during this period (p=0.023).
During the COVID pandemic, most PIs were put forwards for anti-infectious drugs (n=36; 20.3%), acetaminophen (n=31; 17.5%) and anticoagulant drugs (n=17; 9.6%). There were significantly more PIs on anti-infectious drug during the pandemic (p=0.038).
The distribution of the highlighted issues within the prescriptions and the pharmacists’ therapeutic advice is detailed in Table 3.
The most frequently identified problem in the whole data collection was a drug supratherapeutic dosage (n=62, 26.8%) which was followed by a non-conformity to the guidelines or a contraindication (n=54, 23.4%) and the prescription of a drug without an indication (n=48, 20.8%).
Prior to the pandemic, there were significantly more PIs for a drug without an indication (p=0.013) and for a subtherapeutic dosage (p=0.019). During COVID-19, there were significantly more PIs for an improper administration (p=0.021).
For both periods combined 72 PIs (31.2%) were proposed for discontinuing a drug, 57 (24.7%) for adjusting the dosage of a drug and 41 (17.7%) for switching a drug.
Thirty-two PIs (59.3%) were accepted by the medical staff prior to COVID-19.
During the pandemic our PIs acceptance rate was 60.5% (n=107; p=0.875). Table 4 describes the correspondence between therapeutic advice given by the pharmacists and changes of prescriptions by the geriatricians.
The clinical impact of the PIs is detailed in Table 5.
One hundred and one PIs (43.7%) had a moderate clinical impact, 76 (32.9%) a minor impact and 40 (17.3%) a major impact. There was no significant difference between the two groups.