Pharmacist-based deprescribing has been successful in reducing older adults’ exposure to anticholinergic drugs
INDIANAPOLIS — Anticholinergics, a class of drugs commonly prescribed for depression, urinary incontinence and many other common conditions in older adults, affect the brain by blocking acetylcholine, a neurotransmitter in the nervous system that influences memory, alertness and planning skills. A new study by researchers from the Regenstrief Institute, Purdue University College of Pharmacy and Indiana University School of Medicine found that using pharmacists as deprescribing care coordinators decreased the prescribing of anticholinergics by 73% and reduced the cumulative use of these drugs by up to 70%.
“Our new study is important and necessary preliminary work, allowing us to test whether deprescribing these drugs improves clinical outcomes,” said Noll Campbell, PharmD, MS, faculty member of the Regenstrief Institute and Purdue College of Pharmacy. , who led the new study to develop pharmacist-centered delivery models to successfully transition patients to safer medications. “Tackling deprescribing has not been easy. That pharmacist-centered models of deprescribing work so well does not surprise me, because pharmacists are well placed for this task. They are knowledgeable about medications, often have a close relationship with patients, and are well trained in communicating with providers.
The researchers developed two pharmacist-focused models of deprescribing. The first, a face-to-face model, involved pharmacists meeting and monitoring elderly adult patients seen in an aging brain care clinic. The second model, which involved telephone outreach by pharmacists to a generally older adult patient population encouraging safer medications, was less effective in reducing exposure to anticholinergics, but more effective than other methodologies, including including clinician alerts in electronic health records (EHRs). Together, these models reduced the prescription of anticholinergics by 73% and the cumulative use of these drugs by up to 70%.
“Anticholinergic Deprescribing in the Elderly in Primary Care: Experience from Two Models and Impact on Continuous Measurement of Exposure” is published in the Journal of the American College of Clinical Pharmacy (JACCP). The authors, in addition to Dr. Campbell, are Christopher Callahan, MD, and Malaz Boustani, MD, MPH, Regenstrief Institute, IU School of Medicine, and Eskenazi Health; Christopher Pitts, PharmD, and Parveen Chand, MHA, IU Health; Claire Corvari, PharmD, Franciscan Health;Ellen Kaehr, MD,IU School of Medicine; Khalid Alamer, PharmD, PhD Candidate, Purdue University College of Pharmacy; Kristine Nanagas, MD, IU Health and IU School of Medicine.
The study was supported by the National Institute on Aging of the National Institutes of Health [K23AG044440 and R01AG061452] and the Agency for Health Research and Quality [P30HS2 4384].
Using the human-intensive deprescribing methodologies described in the JACCP article, Regenstrief researchers are currently conducting R2D2 – an acronym for “Reducing the Risk of Dementia Through Deprescribing” to determine whether the adverse cognitive effects of anticholinergic drugs are reversible. In this study, which is currently recruiting patients, clinical pharmacists work with physicians and their patients who use anticholinergics to identify and switch to safer alternative medications. The trial also monitors the effect of deprescribing these drugs on depression, anxiety, pain, insomnia and quality of life. Dr. Campbell leads this study funded by the National Institute on Aging of the National Institutes of Health.
About Noll Campbell, PharmD, MS
In addition to his role as a research scientist at the Regenstrief Institute, Noll Campbell, PharmD, MS, is an associate professor of pharmaceutical practice at Purdue University College of Pharmacy. He is an Assistant Professor of Medicine at the IU School of Medicine and maintains an active clinical practice as an expert in geriatric drug therapy with Eskenazi Health.
About the Regenstrief Institute
Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information enables people to end disease and achieve true health. A key research partner of Indiana University, Regenstrief and its researchers are responsible for a growing number of major healthcare innovations and studies. Examples range from developing global health information technology standards that enable the use and interoperability of electronic health records, to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the world.
Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making health care more efficient and accessible to everyone. His vision continues to guide the institute’s research mission.
About Purdue University College of Pharmacy
The mission of Purdue University College of Pharmacy is to advance scientific discovery and development, maximize global health outcomes through patient care and public service, and educate and train students so that they become leading pharmacists and scientists. The goal is to transform the practice and science of pharmacy to drive progress in human health.
About IU School of Medicine
IU School of Medicine is the largest medical school in the United States and is ranked among the top medical schools in the nation annually by US News & World Report. The school provides high-quality medical education, access to cutting-edge medical research, and rich campus life in nine Indiana cities, including rural and urban areas consistently recognized for their quality of life.