In detail

Our research group was created in 2010. In 2014 our group has continued working around 4 main themes

STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment) criteria aim at detecting potentially inappropriate prescribing in older people. We study the value of using the STOPP/START criteria to identify inappropriate prescribing in older patients and to improve practices. After characterizing the prevalence of potentially inappropriate mediciations and potential prescribing omissions in frail older patients admitted to the hospital, we performed a randomized controlled trial to evaluate the effect of the use of STOPP criteria by an inpatient geriatric consultation team. We found that specific STOPP recommendations provided to hospital physicians doubled the reduction of PIMs at discharge in frail older inpatients. However, to further improve the appropriateness of prescribing in older patients, clinicians should focus on the STOPP criteria that are of major clinical importance, and general practitioners should be actively involved. We also explored the perspectives of general practitioners regarding the use of the STOPP&START tool in their practice. Despite variable views on the usefulness, comprehensiveness, and relevance of STOPP&START, GPs suggest the implementation of this tool in primary care within computerized clinical decision support systems, through education, and used as part of multidisciplinary collaborations
A specific case of frequent inappropriate use of medicines in older patients is the underse of anticoagulation for the prevention of cardio-embolism in patients with atrial fibrillation (AF). We aimed at identifying characteristics associated with anticoagulation underuse through a cross-sectional study of 773 consecutive geriatric patients aged ≥75 years, with AF and clear anticoagulation indication. Underuse of anticoagulation was found in 50% of patients, We found that aspirin use was the main characteristic associated with anticoagulation underuse. Surprisingly, individual bleeding or stroke risk did not predict underuse.
In collaboration with KULeuven (Prof V Foulon), we are coordinating a multicentric study funded by the national health insurance (INAMI). The COME-ON (Collaborative approach to Optimise MEdication use for Older people in Nursing homes) study aims to evaluate the effect of a complex intervention involving interdisciplinary collaboration on the appropriateness of use of medicines in Belgian nursing homes. In 2014 the research protocol has been developed and approved, education and training modules have been built, an innovative wen-based data collection platform has been designed and piloting has been performed in four nursing homes. Patient recruitment has just started. In 2015 baseline data will be collected and followed by implementation of the different components of the intervention (education and training, local concertation and multidisciplinary case conferences).
We participated to the submission of a research project within Horizon2020 and were informed of the successful issue in December. The OPERAM project is led by University of Bern and will start in 2015 and we will lead one work package and participate to six other work packages.

Appropriate management of analgo-sedation in the intensive care unit (ICU) is associated with improved patient outcomes. We performed first a qualitative study using face-to-face semistructured interviews with health care professionals from 4 Belgian hospitals, and second a national survey with physicians and nurses (n=898). Our objectives were to describe utilization of analgo-sedation regimens and strategies, and to describe and compare perceptions challenging utilization of these strategies. Overall we found that current analgo-sedation practices leave room for improvement. Physicians and nurses meet different challenges in using appropriate analgo-sedation strategies. Implementational interventions must therefore be tailored according to profession. Barbara Sneyers collaborated to a study on the use of physical restraints in ventilated patients with the Canadian Critical care trial group and nursing critical care trial group. Physical restraint was used in half of the patients in the 51 participating ICUs. Treatment characteristics predominantly predicted physicial restraint use, as opposed to patient or hospital/ICU characteristics. Use of sedative, analgesic, and antipsychotic drugs, agitation, heavy sedation, and occurrence of an adverse event predicted PR use or number of days used. A systematic review on the effect of knowledge translation for pain, analgesia and delirium in intensive care is ongoing.

Hospital discharge is a critical period for continuity of care and unintentional medication discrepancies can occur. We conducted and finalized the analysis of a 10-month cohort study in the geriatric and orthopedic wards of three hospitals, one of these having clinical pharmacists performed medication reconciliation at discharge. After adjusting for possible confounders, we found that the prevalence of unintentional medication discrepancies after discharge was significantly lower in the hospital with clinical pharmacists.
- We started the SEAMPAT project in June 2014. This 3-year project aims to develop and evaluate (a) an electronic tool to be used by patients to enter their medication history and (b) an electronic medication reconciliation tool that will facilitate the identification and resolution of medication discrepancies. We lead the project and work in collaboration with 3 other research groups with various expertise including ethics, sociology and IT. Our research group is currently performing a systematic review on the implementation and effect of electronic medication reconciliation. We also performed focus groups to explore the perspective of patients and healthcare professionals.

Direct oral anticoagulants (DOACs) have been developed to address some of the drawbacks of vitamin-K antagonists. However, special attention should be given when using these drugs, especially in patients with renal insufficiency, questionable compliance, and those at high risk of bleeding.

We performed a prospective cohort on the appropriateness of use of direct oral anticoagulants in 69 patients with atrial fibrillation. We found that half of patients had at least one criterion of inappropriate prescribing. and this possibly led to a severe adverse drug event in several patients.

Collaboration with a clinical pharmacist contributed to better use.

We also collaborated to other research activities led by the Namur Thrombosis and Haemostasis Center and we published several educational papers on the proper use of direct oral anticoagulants.
A new 4-year project entitled “Optimising the use of direct oral anticoagulants in daily clinical practice: from bench to bedside and back again” has just started. In 2015 we will investigate the prevalence of medication errors with DOACS and explore the causes. We will also develop and validate a new biological test.

In addition, a project on the monitoring of β-lactams in severely infected patients is run in collaboration with the research group on cellular and molecular pharmacology (main collaborators: A Bastos, F Van Bambeke, P Tulkens).
In 2015 we also plan to further develop research about the use of clinical decision support and other health information technology to improve quality and safety of patient care regarding medication use. This project will be run in collaboration with the Cliniques universitaires Saint-Luc