Medication optimization pathway in surgery: involving general practitioners and patients during hospitalization and up to 45 days after returning home

Studies show that the medications patients take after being discharged from the hospital often do not match the prescriptions provided at discharge due to inappropriate changes made by patients or community healthcare professionals. To involve a clinical medico-pharmaceutical team during the hospital stay of polymedicated surgical patients in reviewing chronic treatments in collaboration with general practitioners; to support patients post-discharge and ensure information is transmitted to community pharmacists and general practitioners; to assess the impact of this coordinated approach on treatment continuity 45 days post-discharge. This is a prospective multicenter study. Included patients were aged ≥ 65 years, taking ≥ 3 medications for ≥ 3 months, and had a surgical stay of ≥ 1 day. Upon admission, medication reconciliation was performed, followed by a therapeutic review based on STOPP/START criteria, scientific society recommendations, and BEERS criteria. General practitioners were involved in this review process. At discharge, patients underwent medication reconciliation followed by phone calls (Day3, Day45). General practitioners and community pharmacists were informed of follow-up [Discharge = Day0, Day3 (pharmacists) and Day45]. Fifty-one patients completed the study [mean age 74.2 years ± 6.27 (standard deviation)]. Treatment reviews were performed in 39 patients (76.5%), with general practitioner involvement in 36 cases. Prescription re-evaluations applied 36 STOPP criteria, 13 START criteria, 9 scientific society recommendations, 9 internal hospital guidelines, and 28 clinical-pharmacological considerations. Average number of medications: Admission = 7.86 (3.05); Day0 = 7.12 (3.04); Day45 = 7.16 (3.04) [significant decreases between Admission and Day0 (p = 0.0011) and between Admission and Day45 (p = 0.0021)] and no significant changes between Day0 and Day45. BEERS medications: Admission = 1.69 (1.22); Day0 = 1.35 (1.16); Day45 = 1.35 (1.20) [significant decreases between Admission and Day0/Day45 (p = 0.0014)], and no significant changes between Day0 and Day45. This coordination model between hospital and community care, involving general practitioners during hospitalization, represents an innovative approach. It reaffirms the importance of interprofessional collaboration to ensure continuity of care from hospital admission to return home and through post-hospitalization follow-up.