Background and importance The anticholinergic burden has been repeatedly associated with adverse events in elderly patients.
Aim and objectives We aimed to determine the acceptance of a pharmacist-led intervention to reduce the anticholinergic burden.
Material and methods Design: interventional prospective study carried out from January to May 2021.
Population: institutionalised patients from a Spanish nursing home.
Variables collected: sex, age, prescribed drugs, prescribed anticholinergic drugs (ADs) according to Drug Burden Index (https://www.anticholinergicscales.es/), Charlson Comorbidity index, Barthel index, intervention proposals and intervention acceptance.
Pharmacists led the design of the treatment interventions: every patient was interviewed and their treatment reviewed; the pharmacist then proposed treatment modifications of ADs on deprescription (withdrawal, dose reduction or switch), these modifications were evaluated by physicians and later offered to patients.
The study was carried out according to national ethical standards, and patients’ written consents were collected.
Statistical analyses were carried out with Pearson’s Chi-square test.
Results Overall, of 157 patients who resided in the nursing home, 99 (63.1%) received anticholinergics and were assessed for intervention. 59.6% men, mean age 72.5±7.9 years, median Charlson Comorbidity index: 2 (0–9), mean Barthel index: 88.0±15.2. Median prescribed drugs: 10 (1–19), median prescribed ADs: 2 (1–5).
Treatment modifications were proposed for 37 patients who received a total of 85 ADs. Overall, 97 treatment modification proposals were designed.
39 interventions were finally accepted. No statistically significant differences in acceptance were found according to intervention design (p>0.05).
The ADs most frequently proposed for intervention were: tramadol (15), pregabalin (9), lorazepam (8), alprazolam (8) and tamsulosin (7).
Interventions over anxiolytics and sedatives were rejected significantly more often by patients when compared to other drugs (p<0.005).
Conclusion and relevance A significant percentage of physicians and patients rejected the proposed interventions. The success of the intervention was limited by the patient’s rejection, particularly in treatment modifications of anxiolytics and sedatives.
This study suggests that pharmacists may find it difficult to achieve anticholinergic burden reductions by suggesting AD changes to physicians and patients.
Conflict of interest No conflict of interest
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