A drug deprescribing study that included pharmacists as care coordinators reduced anticholinergics prescriptions by 73%, researchers report.
Anticholinergics are a class of drugs that are frequently prescribed to treat numerous common conditions in older adults, including urinary incontinence and depression. They work by blocking the neurochemical acetylcholine in the brain and have been linked with dementia, including a 26% increased risk of dementia among elderly nursing home residents with depression.
Personalized oversight
The researchers studied two deprescribing models that employed the pharmacist coordinator. One involved face-to-face meetings meeting with and monitoring older adult patients who were seen in a brain care clinic. The other model examined outcomes of pharmacist outreach via telephone to an older adult patient population that encouraged safer medications.
In the clinic-based model, 23 of 24 medications deemed eligible for deprescribing were deprescribed (defined as a discontinuation or dose reduction reported either self-reported or reported in clinical records). It also resulted in a 93% reduction in median annualized total standardized dose, and 56% of patients lowered their exposure below a cognitive risk threshold, reported Noll Campbell, PharmD, MS, of the Regenstrief Institute and Purdue College of Pharmacy in Indianapolis.
The second was less effective in reducing exposure to anticholinergics. But it still topped other methodologies, such as including clinician alerts in electronic health records, Campbell and colleagues reported.
Together, the measures decreased prescriptions by 73% and reduced the cumulative use of the drugs up to 70%.
Not an easy task
“Tackling deprescribing has not been easy. That pharmacist-centric deprescribing models work so well does not surprise me because pharmacists are well suited for the task,” Campbell said in a statement. “They are knowledgeable about medications, often have a close relationship with the patients and are well trained to communicate with providers.”
Full findings were published in the Journal of the American College of Clinical Pharmacy.
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