Abstract
Introduction: Increasing Drug Burden Index (DBI) score, caused by the prescription of anticholinergic and sedative medications, is associated with poor outcomes in older people.
Aim: We aimed to reduce DBI in older people in the community, by implementing a pharmacist-led intervention to facilitate deprescribing of anticholinergic and sedative medications where appropriate. Our secondary aim was to investigate the effect size by frailty subgroup. Methods: This was a pragmatic two-arm randomised controlled trial comparing pharmacist-led recommendations to general practitioners (GPs) for deprescribing anticholinergic and sedative medication (the intervention)
with usual care (control). Older people (≥65 years) were recruited from Canterbury and South Canterbury, New Zealand, if they were taking at least one anticholinergic or sedative medication. The primary outcome measure was the difference in DBI between medication assessment at baseline and follow-up. Frailty subgroups were defined using the Frailty Index. Summary data are presented as n (%) and means (standard deviation) or medians (inter-quartile range). Proportions were compared
with Pearson’s chi-squared test and presented with a confidence interval. Results: Interim findings suggest that of 363 participants who had a medication assessment, 21 (12.7%) in the control group and 21 (12.2%) in the intervention group had
a reduction in DBI≥0.5. The mean difference in DBI was -0.4% (95%CI -7.9% to 7.0%, n.s.). Complete study findings will be presented. Discussion: Our pharmacist-led medication assessment of older people living in the community was not effective at
reducing the anticholinergic and sedative load, measured with DBI, after three months of our deprescribing implementation strategy. There was a lack of evidence to suggest that this strategy was effective for any frailty subgroup. Further research into strategies to increase translation of deprescribing into practice is needed.
Aim: We aimed to reduce DBI in older people in the community, by implementing a pharmacist-led intervention to facilitate deprescribing of anticholinergic and sedative medications where appropriate. Our secondary aim was to investigate the effect size by frailty subgroup. Methods: This was a pragmatic two-arm randomised controlled trial comparing pharmacist-led recommendations to general practitioners (GPs) for deprescribing anticholinergic and sedative medication (the intervention)
with usual care (control). Older people (≥65 years) were recruited from Canterbury and South Canterbury, New Zealand, if they were taking at least one anticholinergic or sedative medication. The primary outcome measure was the difference in DBI between medication assessment at baseline and follow-up. Frailty subgroups were defined using the Frailty Index. Summary data are presented as n (%) and means (standard deviation) or medians (inter-quartile range). Proportions were compared
with Pearson’s chi-squared test and presented with a confidence interval. Results: Interim findings suggest that of 363 participants who had a medication assessment, 21 (12.7%) in the control group and 21 (12.2%) in the intervention group had
a reduction in DBI≥0.5. The mean difference in DBI was -0.4% (95%CI -7.9% to 7.0%, n.s.). Complete study findings will be presented. Discussion: Our pharmacist-led medication assessment of older people living in the community was not effective at
reducing the anticholinergic and sedative load, measured with DBI, after three months of our deprescribing implementation strategy. There was a lack of evidence to suggest that this strategy was effective for any frailty subgroup. Further research into strategies to increase translation of deprescribing into practice is needed.
| Original language | English |
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| Publication status | Published - 2021 |
| Event | Proceedings of the Australasian Pharmaceutical Science Association (APSA) Annual Conference - Duration: 6 Dec 2021 → 12 Dec 2021 |
Conference
| Conference | Proceedings of the Australasian Pharmaceutical Science Association (APSA) Annual Conference |
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| Period | 6/12/21 → 12/12/21 |