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

Autor: Campbell NL; Department of Pharmacy Practice Purdue University College of Pharmacy West Lafayette Indiana USA.; Indiana University Center for Aging Research, Regenstrief Institute, Inc. Indianapolis Indiana USA.; Center for Health Innovation and Implementation Science Indiana University School of Medicine Indianapolis Indiana USA.; Sandra Eskenazi Center for Brain Care Innovation Eskenazi Health Indianapolis Indiana USA., Pitts C; Ascenscion St. Vincent North Region Evansville Indiana USA., Corvari C; Department of Pharmacy Franciscan Health Indianapolis Indiana USA., Kaehr E; Sandra Eskenazi Center for Brain Care Innovation Eskenazi Health Indianapolis Indiana USA.; Department of Medicine Indiana University School of Medicine Indianapolis Indiana USA., Alamer K; Department of Pharmacy Practice Purdue University College of Pharmacy West Lafayette Indiana USA., Chand P; Ascenscion St. Vincent North Region Evansville Indiana USA., Nanagas K; Ascenscion St. Vincent North Region Evansville Indiana USA.; Department of Medicine Indiana University School of Medicine Indianapolis Indiana USA., Callahan CM; Indiana University Center for Aging Research, Regenstrief Institute, Inc. Indianapolis Indiana USA.; Center for Health Innovation and Implementation Science Indiana University School of Medicine Indianapolis Indiana USA.; Sandra Eskenazi Center for Brain Care Innovation Eskenazi Health Indianapolis Indiana USA.; Department of Medicine Indiana University School of Medicine Indianapolis Indiana USA., Boustani MA; Indiana University Center for Aging Research, Regenstrief Institute, Inc. Indianapolis Indiana USA.; Center for Health Innovation and Implementation Science Indiana University School of Medicine Indianapolis Indiana USA.; Sandra Eskenazi Center for Brain Care Innovation Eskenazi Health Indianapolis Indiana USA.; Department of Medicine Indiana University School of Medicine Indianapolis Indiana USA.
Jazyk: angličtina
Zdroj: Journal of the American College of Clinical Pharmacy : JACCP [J Am Coll Clin Pharm] 2022 Oct; Vol. 5 (10), pp. 1039-1047. Date of Electronic Publication: 2022 Jul 31.
DOI: 10.1002/jac5.1682
Abstrakt: 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.
Conclusions: Pharmacist-based deprescribing successfully reduced exposure to high-risk anticholinergics in primary care older adults, yet further work is needed to understand the impact on clinical outcomes.
Competing Interests: The authors declare no conflicts of interest.
(© 2022 The Authors. JACCP: Journal of the American College of Clinical Pharmacy published by Wiley Periodicals LLC on behalf of Pharmacotherapy Publications, Inc.)
Databáze: MEDLINE
Externí odkaz: