4CPS-006 Clinical pharmacist interventions within a geriatric mobile team

<h3>Background and Importance</h3> Frail and complex older inpatients might receive an intervention from the Geriatric Mobile Team (GMT) of our hospital after request. The GMT provides specialised medico-social advice and optimises the patients’ care. Since 2020, a clinical pharmacist works with the GMT on the patients’ drug management by carrying out medication reconciliation and pharmaceutical analysis of their prescription within a national care pathway for the elderly. <h3>Aim and Objectives</h3> The aim of this study is to assess the pharmacist activity within the GMT and its potential impact on drug management and hospital readmission at 3 months after discharge. <h3>Material and Methods</h3> All inpatients assessed by the GMT and hospitalised in acute medicine unit, arrived via the emergency department, between 1 January 2020 and 31 December 2023 were included in this retrospective cohort study. The variables collected were: age, sex, length of stay, readmission in the hospital in the 3 months after discharge, drug class managed by the PI, drug related problems (DRP) identified, nature of the advice given, and acceptance rate by doctors. A PI is notified in the prescription software and can be discussed orally with the medical team. They are considered as accepted if they lead to a change in the prescription. <h3>Results</h3> Overall, 203 patients were included (mean age 87.4 ± 5.7 years, 51.7% female). Among them, 138 had a PI in their prescription: 246 PIs in total with an acceptance rate of 76.4%. Patients with a PI had longest length of stay (18.7 ± 12.5 vs 14.6 ± 6.2 days, p=0.01) and more prescribed drugs (9.2 ± 3.6 vs 7.8 ± 3.3, p = 0.01). No significant difference was observed in readmission rate (28.1% vs 33.9%, p=0.49). The drugs with most PIs were ‘supplements’ (14.6%), ‘proton pump inhibitors’ (10.6%) and ‘anticoagulants’ (8.5%). The most frequent DRPs highlighted were ‘Non conformity to guidelines or contraindication’ (28.1%), ‘Supratherapeutic dosage’ (24.4%) and ‘Drug without indication’ (23.2%). The advice proposed by the pharmacist were ‘Dose adjustment’ (32.5%), ‘Drug switch’ (26.4%) and ‘Drug discontinuation’ (22.4%). <h3>Conclusion and Relevance</h3> This multidisciplinary team encourages optimal prescriptions in these complex inpatients. Further research is necessary to explore and improve our impact on the patients’ readmission rate. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest