Alternative Medications for Medications in the Use of High‐Risk Medications in the Elderly and Potentially Harmful Drug–Disease Interactions in the Elderly Quality Measures

Abstract

The National Committee for Quality Assurance (NCQA) and the Pharmacy Quality Alliance (PQA) use the American Geriatrics Society (AGS) Beers Criteria to designate the quality measure Use of High-Risk Medications in the Elderly (HRM). The Centers for Medicare and Medicaid Services (CMS) use the HRM measure to monitor and evaluate the quality of care provided to Medicare beneficiaries. NCQA additionally uses the AGS Beers Criteria to designate the quality measure Potentially Harmful Drug–Disease Interactions in the Elderly. Medications included in these measures may be harmful to elderly adults, negatively affect a health care plan’s quality ratings, and be denied as a health care plan drug benefit. Prescribers, pharmacists, patients, and health care plans may benefit from evidence-based alternative medication treatments to avoid these problems. Therefore the goal of this work was to develop a list of alternative medications to those included in the two measures. The authors conducted a comprehensive literature review for 2000 to 2014 and a search of their personal files. From the evidence, they prepared a list of drug-therapy alternatives with supporting references. A reference list of non-pharmacological approaches was also provided when appropriate. NCQA, PQA, the 2015 AGS Beers Criteria panel, and the Executive Committee of the AGS reviewed the drug therapy alternatives and nonpharmacological approaches. Recommendations by these groups were incorporated into the final list of alternatives. The final product of drug-therapy alternatives to medications included in the two quality measures and some nonpharmacological resources will be useful to health professionals, consumers, payers, and health systems that care for older adults.

Anticholinergic Prescribing in Medicare Part D Beneficiaries Residing in Nursing Homes: Results from a Retrospective Cross-Sectional Analysis of Medicare Data

“…Modification may be fairly straightforward for medications such as tricyclic antidepressants, which may be substituted with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) to manage depression. 38 Whereas, the use of antipsychotics such as quetiapine or olanzapine may require careful consideration of other factors before considering an alternative such as risperidone for managing behavioral complications of dementia. 38 The same logic can also be applied to guide the initiation of new therapies, particularly among patients with existing anticholinergic burden, in an effort to reduce additional risk for adverse events.…”

“…38 Whereas, the use of antipsychotics such as quetiapine or olanzapine may require careful consideration of other factors before considering an alternative such as risperidone for managing behavioral complications of dementia. 38 The same logic can also be applied to guide the initiation of new therapies, particularly among patients with existing anticholinergic burden, in an effort to reduce additional risk for adverse events. For example, a prescriber wishing to treat symptoms of nausea and vomiting may choose to initiate ondansetron, which has no anticholinergic activity, instead of an agent with high-level anticholinergic properties, such as promethazine.…”

Patterns of Dementia Treatment and Frank Prescribing Errors in Older Adults With Parkinson Disease

“…It is more difficult to defend concurrent use of a high potency ACH drug simultaneously with an ACHEI, considering that all high potency ACH drugs have low- ACH potency, non-anticholinergic and non-drug alternatives. 23 Thus, our primary analyses focused on high-potency ACH drugs..…”

Anticholinergic drugs and dementia in older adults

“…As suggested by guidelines, anticholinergics in general should be avoided in older adults 1112. Specifically, for most highly anticholinergic drugs, non-pharmacological and pharmacological alternatives are available and should be considered 1314…”