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Evaluation of ambulance transport relevance of dialysis patients in the PACA region (France), and estimation of savings by the Health Insurance Volume 18, issue 1, Février 2022

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Authors

Background

Older patients with advanced chronic kidney disease may be exposed to a higher risk of adverse drug events due to chronic kidney disease and aging. The integration of clinical pharmacist into pretransplant comprehensive geriatric assessment is an opportunity to perform medication optimization.

Objective

The aim was to describe drug-related problems in older patients with advanced chronic kidney disease.

Methods

Observational study was conducted with retrospective data from July 2017 to April 2019. Patients≥65 years with advanced chronic kidney disease, referred by nephrologists for pretransplant comprehensive geriatric assessment were included. During medication optimization, the pharmacist evaluated the appropriateness of each medication prescribed and identified drug-related problems. Any drug-related problem identified lead to a pharmaceutical intervention.

Results

In total, 103 patients were included (74.5±2.9 years, 26.2% female, 47.6% on dialysis). Overall, 394 drug-related problems were identified in 93.2% of patients (3.8±2.4 drug-related problems per patient) during the medication optimization. Cardiovascular medications (25.1%), antithrombotics (13.5%) and drugs for peptic ulcer and reflux disease (10.2%) were the most involved drugs in drug-related problems. Drug-related problems mainly concerned drugs without indication (27.1%), inappropriate method of administration (24.4%) and non-conformity to guidelines (20.1%).

Conclusion

A high prevalence of drug-related problems in older patients with advanced chronic kidney disease was identified during medication optimization. The systematic integration of a clinical pharmacist in the multidisciplinary team performing pretransplant comprehensive geriatric assessment may be relevant to detect inappropriate prescriptions and to prevent from adverse drug events.

Introduction

Le transport de patients représente le second poste de dépenses de dialyse après l’hospitalisation. De nombreux patients transportés en ambulance sont autonomes à la marche.

Description

Une étude a été réalisée en région PACA afin d’analyser le profil des patients transportés en ambulance et autonomes à la marche, puis d’estimer les économies réalisables par l’Assurance maladie.

Méthodes

Une triangulation a été effectuée à partir des données des patients hémodialysés enregistrés dans le Registre REIN en 2017 et celles issues de deux enquêtes réalisées : l’une auprès d’un échantillon de patients, transportés en ambulance et autonomes à la marche, et l’autre auprès de 62 néphrologues.

Résultats

Les données REIN ont permis d’estimer que 44 % des patients transportés en ambulance étaient autonomes à la marche. Notre étude a montré que deux tiers de ces patients ont un motif pour être transportés en ambulance ; pour le tiers sans motif, les économies seraient d’environ 2 millions d’euros par an, avec une requalification de leur transport en transport assis. L’enquête réalisée auprès des prescripteurs a montré qu’il existe des dérogations justifiées en raison d’une dégradation temporaire de l’état de santé et/ou de conditions de logement, mais aussi en raison de la carence en transport assis.

Conclusion

Un tiers des patients transportés en ambulance et autonomes à la marche aurait un transport non pertinent. Ceci s’expliquerait par la fluctuation de l’état de santé des patients et serait également lié à la carence en transport assis. Des économies sont possibles et dépendent en partie de l’amélioration du pilotage de l’offre.

Introduction

Patient transport represents the second largest item of cost of dialysis after hospitalization. A significant proportion of patients transported by ambulance are self-sufficient for walking.

Description

A study was carried out in the PACA region (France) to analyse the profile of patients transported by ambulance and self-sufficient for walking and then to evaluate the savings for the Health Insurance.

Methods

A triangulation of data was carried out using data from haemodialysis patients recorded in the French REIN Registry in 2017 and data from two surveys: one of a sample of patients transported by ambulance and autonomous in walking, and the other of 62 nephrologists.

Results

The data from the REIN register allowed us to estimate that 44 % of patients transported by ambulance are self-sufficient for walking. Our study allowed us to estimate that 2/3 of patients transported by ambulance, self-sufficient for walking, have a reason for being transported by ambulance; for the third without a reason, the health insurance savings would amount to €2 million per year with a reclassification of their transport as seated transport. The survey of prescribers showed that there are exemptions justified by a temporary deterioration in health and/or housing conditions, but also by the lack of seated transport.

Conclusion

One third of the patients, transported by ambulance and self-sufficient for walking, would have an inappropriate transport. This would be explained by the fluctuating state of health of the patients and would also linked to the lack of seated transportation. Savings are possible and depend in part on improved management of the supply.