Background and Importance Patients’ anticholinergic burden is the cumulative effect of taking one or more anticholinergic medications. It is associated with adverse outcomes such as falls, cognitive impairment, delirium and increased morbidity, especially in elderly. Previous studies demonstrated that hospitalisation may increase anticholinergic burden. Pharmacotherapeutic interventions supported by electronic clinical decision support (eCDS) may have the potential to prevent this.
Aim and Objectives The aim of this study was to investigate whether the anticholinergic burden, expressed as score on the Anticholinergic Burden Scale (ACB score), in older hospitalised patients could be reduced through performing eCDS-based interventions during hospitalisation.
Material and Methods Prospective intervention study in April and May 2022. Study population: patients ≥65 years with an ACB score ≥8 and a hospital stay of ≥3 days. An eCDS tool was used to detect patients that met inclusion criteria. Patients’ anticholinergic medication was reviewed and intervened if possible. An intervention consisted of pharmacist-led advice to the patient’s attending physician by phone. Primary outcome: number and proportion of patients whose anticholinergic burden was reduced by the interventions. Secondary outcomes: (i) acceptance rate of pharmacotherapeutic interventions by attending physicians and (ii) nature and frequency of anticholinergic side effects. Descriptive statistics were used to analyse the results.
Results 208 patients were included (44.7% female; mean age 75.7 ( ± 6.6) years). Anticholinergic medication of 43 patients was reviewed which led to 43 interventions for 23 patients (53.5%, mean 1.87 ( ± 0.81) interventions per patient): 7 suggestions for dose reduction (16.3%), 4 suggestions for alternative medication (9.3%) and 32 suggestions for discontinuation of medication (74.4%). 28 of the 43 interventions were directly accepted by the attending physician (acceptance rate 65.1%) leading to a total ACB score reduction of 41 points i.e. an average ACB score reduction of 1.46 points ( ± 0.79) per intervention. 33 of the 43 reviewed patients (76.7%) experienced one or more anticholinergic side effects. Constipation occurred most often (45.2%).
Conclusion and Relevance Anticholinergic burden was reduced through eCDS-based pharmacotherapeutic interventions in more than half of reviewed patients and acceptance by attending physicians was high, indicating a promising potential for this initiative in clinical practice.
Conflict of Interest No conflict of interest
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