An intervention to reduce anticholinergic prescribing in hospitalised older adults

<p>Introduction: Globally, there is great interest among clinicians, researchers, and policymakers (e.g., Aged Care Royal Commission) in mitigating anticholinergic drug-related hospital admissions and the associated healthcare burden. There is substantial evidence that drugs with anticholinergic properties, especially when used in combination (anticholinergic burden), carry significant risks in older people, including increased hospital admissions and greater incidence of falls, cognitive impairment, and death. Their use in combination is highly problematic, but can easily go unnoticed. The aim of this study was to design, implement, and evaluate an intervention to reduce the use of anticholinergic-type drugs in hospitalised older adults.<br>Method: This study explored the effectiveness of an educational intervention led by a clinical pharmacist and a geriatrician to reduce anticholinergic drug prescribing within the Royal Hobart Hospital, Australia. We included hospitalised patients aged 65 years and above, and their exposure to anticholinergic drugs was identified using a composite rating scale. The extent of anticholinergic drug prescribing was measured before and after implementing the intervention (3 months, Oct-Dec 2022). Change in mean anticholinergic burden score was analysed using the Mann-Whitney U test.<br>Results: The study retrospectively analysed 350 older patients in the pre-intervention (Jan-Sep 2022) and 350 older patients in the post-intervention (Jan-Mar 2023) period using the digital medical record. We found a significant reduction in pre-to post-intervention on total anticholinergic drug burden and the number of anticholinergic prescriptions (13% reduction, p<0.05) at discharge. Besides, the use of high anticholinergic activity medicines (10.8%) and polypharmacy (17.7%) showed a significant reduction at discharge from the pre-post intervention period. An evaluation survey from the education workshops showed (n=16) a high satisfaction rate (>95%) among the participants, and the topic was highly regarded among doctors and pharmacists.<br>Conclusion: To our knowledge, this was the first intervention study conducted to lessen anticholinergic prescribing in a hospital setting. The success of the 3-month intervention period was evaluated using a pre-post comparison of anticholinergic prescriptions at hospital discharge. Overall, the educational intervention piloted in this project has improved the awareness of anticholinergic drug burden in community-dwelling older adults being admitted to the Royal Hobart Hospital and led to improved anticholinergic prescribing with subsequent benefits in the health outcomes for older Australians. Our research facilitated an intervention for a sustainable quality improvement model to further improve prescribing of anticholinergic medications.</p>