Pharmacist-Based Deprescribing Reduced Prescription, Cumulative Use of High-Risk Drugs in Older Adults

Two pharmacist-based deprescribing models reduced the use and prescription of anticholinergics, a high-risk drug in older adults, providing evidence for the use of pharmacists is practitioners of deprescribing.

Using pharmacists as deprescribing care coordinators decreased prescription of high-risk anticholinergics in older adults by 73% and reduced cumulative use of these drugs by as much as 70%, according to a study published in the Journal of the American College of Clinical Pharmacy.

Anticholinergics are a class of drugs frequently prescribed for depression, urinary incontinence, and many other common conditions in older adults. These drugs affect the brain by blocking acetylcholine, a nervous system neurotransmitter that influences memory, alertness, and planning skills.

While pharmacists have previously been identified as ideal practitioners to conduct deprescribing, the authors note that few deprescribing models beyond collaborative consults have been studied.

Researchers from Purdue University College of Pharmacy and Indiana University School of Medicine developed and studied 2 pharmacist-focused deprescribing models to evaluate the impact of pharmacist-based advanced practice models within primary care. In this study, deprescribing was defined as a discontinuation or dose reduction reported either in clinical records or through self-reporting.

The first was a face-to-face model involving pharmacists meeting with and monitoring older patients being seen in an aging brain care clinic. The 18 patients receiving this model were 55 years of age or older and referred for deprescribing at a specialty clinic.

In this model, 23 of 24 (96%) of medications deemed eligible for deprescribing were deprescribed.

The second model involved pharmacist outreach via telephone to an older adult patient population encouraging safer medications. The 24 patients receiving this model were 65 years of age and older and called by a clinical pharmacist for deprescribing without referral.

In this model, 12 of 24 (50%) medications deemed eligible for deprescribing were deprescribed.

Therefore, the second model was less effective in diminishing exposure to anticholinergics than the first model. However, the second model was still more effective than other methodologies, such as clinician alerts, in electronic health records.

The clinic-based deprescribing model resulted in a 93% reduction in median annualized total standardized dose (TSD). Of participating patients, 56% lowered their annualized exposure below a cognitive risk threshold. Four (17%) of the medications were represcribed within 6 months.

For the telephone-based model, there was no change in median annualized TSD, though the annualized TSD was lowered below a cognitive risk threshold in 46% of the patients. For this group, no medications were represcribed within 6 months.

Collectively, the 2 models decreased prescription of anticholinergics by 73% and reduced cumulative use of these drugs as much as 70%. Few withdrawal symptoms or adverse events were reported among groups.

These findings are significant, considering that deprescribing interventions delivered through the electronic medical record have not significantly reduced the use of high-risk anticholinergics in prior trials.

"Our new study is important, necessary preliminary work, enabling us to test whether deprescribing these drugs improves clinical outcomes," said Regenstrief Institute and Purdue College of Pharmacy faculty member Noll Campbell, PharmD, MS, who led the study.

"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. They are knowledgeable about medications, often have a close relationship with the patients and are well trained to communicate with providers," Campbell concluded.

However, the authors assert that further research is necessary to understand the impact of pharmacist-based deprescribing on clinical outcomes.

Reference

Pharmacist-based deprescribing successfully reduced older adults’ exposure to anticholinergic drugs. ScienceDaily. News release. July 21, 2022. Accessed July 25, 2022. https://www.sciencedaily.com/releases/2022/07/220721101533.htm