Evaluation of a pharmacist-led pilot service based on the anticholinergic risk scale

Hanus, Rebecca J.; Lisowe, Kristina S.; Eickhoff, Jens; Kieser, Mara A.; Statz-Paynter, Jamie L.; Zorek, Joseph A.

doi:10.1016/j.japh.2016.02.015

Cited by 7 publications

(22 citation statements)

References 32 publications

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“…There was a general lack of adequate blinding between study subjects and healthcare practitioners, and between outcomes and assessors. Nonetheless, the follow-up duration was either not clearly specified or insufficient (less than six months) in many studies [21][22][23]29,[40][41][42][43][44]48,[50][51][52][53][54][55]. Altogether, the studies had a duration of follow-up ranging from 14 days [40,48] to 1 year [45,46,49] (Table 2).…”

Section: Methodological Quality Of Studiesmentioning

confidence: 99%

“…The countries of origin were USA (n = 5) [29,[38][39][40][41], Australia (n = 4) [22,23,42,43], Finland (n = 2) [44,45], Norway (n = 2) [21,46], Ireland [47], New Zealand [48], Belgium [49], Spain [50], Sweden [51], Sweden [30], France [52], Italy [53], Taiwan [54], and The Netherlands [55].…”

Section: Overview Of the Included Studiesmentioning

confidence: 99%

“…The study settings included hospitals (n = 7) [40,41,44,46,50,52,53] community/primary care (n = 7) [22,30,38,47,49,51,55] and nursing homes/aged care facilities (n = 9) [21,23,29,39,42,43,45,48,54]. There were ten cross-sectional studies [22,38,40,[42][43][44]46,51,52,54], six nonrandomised or pre/post studies [30,39,47,48,50,53], and seven RCTs [21,23,29,41,45,49,55]. The studies included in this study had sample sizes ranging from 46 to 46,078 study subjects.…”

Section: Overview Of the Included Studiesmentioning

confidence: 99%

“…Sixteen studies (70%) [21,22,29,30,[38][39][40]42,43,46,48,[50][51][52]54,55] investigating a healthcare practitioner-oriented intervention reported a significant reduction in anticholinergic prescribing errors, whereas seven studies (30%) [23,41,44,45,47,49,53] reported no significant effect (Table 2). Similarly, medication review (n = 8) and the provision of education (n = 4) were the most common interventions in these sixteen studies; however, these studies varied in their designs.…”

Section: Effectiveness Of Interventions At Improving Anticholinergic ...mentioning

confidence: 99%

“…Healthcare practitioner-oriented interventions that reported a significant reduction in anticholinergic prescribing errors included: medication review, education provision to healthcare practitioners, pharmacist-led electronic health record-based population health initiative and anticholinergic risk scale service, targeted patient-centred, pharmacistphysician team MTM intervention, context-aware pharmaceutical analysis tool, and SÄK-LÄK project. Healthcare practitioner-oriented interventions were most effective in reducing ACB [21,29,40,54], DBI [22,42,48,50], and discontinuation or reduction of anticholinergic medications [30,38,39,43,46,51,52,55]. Hernandez et al 2020 reported a decline in DBI from 1.38 (control group) to 1.08 (intervention group) [50].…”

Section: Effectiveness Of Interventions At Improving Anticholinergic ...mentioning

confidence: 99%

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Effectiveness of Interventions to Improve the Anticholinergic Prescribing Practice in Older Adults: A Systematic Review

Salahudeen

Alfahmi

Farooq³

et al. 2022

JCM

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Background: Pharmacotherapy in older adults is one of the most challenging aspects of patient care. Older people are prone to drug-related problems such as adverse effects, ineffectiveness, underdosage, overdosage, and drug interactions. Anticholinergic medications are associated with poor outcomes in older patients, and there is no specific intervention strategy for reducing drug burden from anticholinergic activity medications. Little is known about the effectiveness of current interventions that may likely improve the anticholinergic prescribing practice in older adults. Aims: This review seeks to document all types of interventions aiming to reduce anticholinergic prescribing among older adults and assess the current evidence and quality of existing single and combined interventions. Methods: We systematically searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO from January 1990 to August 2021. Only studies that examined the effect of interventions in older people focused on improving compliance with anticholinergic prescribing guidelines with quantifiable data were included. The primary outcome of interest was to find the effectiveness of interventions that enhance the anticholinergic prescribing practice in older adults. Results: We screened 3168 records and ended up in 23 studies that met the inclusion criteria. We found only single-component interventions to reduce anticholinergic prescribing errors in older people. Pharmacists implemented interventions without collaboration in nearly half of the studies (n = 11). Medication review (43%) and education provision (26%) to healthcare practitioners were the most common interventions. Sixteen studies (70%) reported significant reductions in anticholinergic prescribing errors, whereas seven studies (30%) showed no significant effect. Conclusion: This systematic review suggests that healthcare practitioner-oriented interventions have the potential to reduce the occurrence of anticholinergic prescribing errors in older people. Interventions were primarily effective in reducing the burden of anticholinergic medications and assisting with deprescribing anticholinergic medications in older adults.

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Section: Methodological Quality Of Studiesmentioning

confidence: 99%

Section: Overview Of the Included Studiesmentioning

confidence: 99%

Section: Overview Of the Included Studiesmentioning

confidence: 99%

Section: Effectiveness Of Interventions At Improving Anticholinergic ...mentioning

confidence: 99%

Section: Effectiveness Of Interventions At Improving Anticholinergic ...mentioning

confidence: 99%

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Effectiveness of Interventions to Improve the Anticholinergic Prescribing Practice in Older Adults: A Systematic Review

Salahudeen

Alfahmi

Farooq³

et al. 2022

JCM

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Deprescribing anticholinergics in primary care older adults: Experience from two models and impact on a continuous measure of exposure

Campbell

Pitts

Corvari

et al. 2022

J Am Coll Clin Pharm

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Background: Deprescribing interventions delivered through the electronic medical record have not significantly reduced the use of high-risk anticholinergics in prior trials. Pharmacists have been identified as ideal practitioners to conduct deprescribing; however, little experience beyond collaborative consult models has been published.Objective: To evaluate the impact of two pilot pharmacist-based advanced practice models nested within primary care. Methods: Pilot studies of a collaborative clinic-based pharmacist deprescribing intervention and a telephone-based pharmacist deprescribing intervention were conducted. Patients receiving the clinic-based pharmacy model were aged 55 years and older and referred for deprescribing at a specialty clinic. Patients receiving the telephone-based pharmacy model were aged 65 years and older and called by a clinical pharmacist for deprescribing without referral. Deprescribing was defined as a discontinuation or dose reduction reported either in clinical records or through self-reporting. Results:The 18 patients receiving clinic-based deprescribing had a mean age of 68 years and 78% were female. Among 24 medications deemed eligible for deprescribing, 23 (96%) were deprescribed. The clinic-based deprescribing model resulted in a 93% reduction in median annualized total standardized dose (TSD), 56% lowered their annualized exposure below a cognitive risk threshold, and 4 (17%) of medications were represcribed within 6 months. The 24 patients receiving telephone-based deprescribing had a mean age of 73 years and 92% were female. Among 24 medications deemed eligible for deprescribing, 12 (50%) were deprescribed. There was no change in the median annualized TSD, the annualized TSD was lowered below a cognitive risk threshold in 46%, and no medications were represcribed within 6 months.Few withdrawal symptoms or adverse events were reported in both groups.

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Interventions to Reduce Anticholinergic Burden in Adults Aged 65 and Older: A Systematic Review

Nakham

Myint

Bond

et al. 2020

Journal of the American Medical Directors Association

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Evaluation of a pharmacist-led pilot service based on the anticholinergic risk scale

Cited by 7 publications

References 32 publications

Effectiveness of Interventions to Improve the Anticholinergic Prescribing Practice in Older Adults: A Systematic Review

Effectiveness of Interventions to Improve the Anticholinergic Prescribing Practice in Older Adults: A Systematic Review

Deprescribing anticholinergics in primary care older adults: Experience from two models and impact on a continuous measure of exposure

Interventions to Reduce Anticholinergic Burden in Adults Aged 65 and Older: A Systematic Review

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