Medication review in older adults at hospital discharge: an analysis of data from the IATROPREV study

Reducing drug-related problems is a major challenge in older adults taking multiple medications. The IATROPREV program aims to improve prescribing appropriateness through multidisciplinary medication optimization, a personalized pharmaceutical plan (PPP), and direct, structured communication between hospital and community healthcare professionals. To analyze the medication optimizations generated by IATROPREV and validated by healthcare professionals through inclusion in PPPs. Potentially inappropriate medications (PIMs) were identified using the Anatomical Therapeutic Chemical (ATC) classification and the REview of potentially inappropriate MEDIcation pr(e)scribing in Seniors (REMEDI(e)S) criteria.

IATROPREV was a prospective, observational, multicenter study (2021-2024) conducted in two French university hospitals. It involved 504 patients admitted to geriatric units. Multidisciplinary meetings brought together geriatricians, attending physicians, hospital pharmacists, and community pharmacists. The patients' prescriptions before and after hospitalization were compared, and PIMs were screened using 73 REMEDI[e]S criteria.

A total of 4977 prescriptions were analyzed. 38% of the recommendations involved discontinuations, 20% modifications, and 37% additions. 42% of prescriptions remained unchanged. Most optimizations targeted ATC classes A (alimentary tract and metabolism), C (the cardiovascular system), and N (the nervous system). Additions mainly involved class A drugs (e.g., laxatives, vitamins), while discontinuations frequently affected class C drugs (e.g., renin-angiotensin-aldosterone system inhibitors, lipid-lowering drugs). PIMs decreased from 1437 at inclusion to 936 at discharge (-35%), with variations across REMEDI[e]S criteria.

IATROPREV highlights the complexity of medication optimizations in geriatrics. Although the REMEDI[e]S criteria enable partial assessment, they do not fully capture all clinically relevant adjustments made through the program.