Impact of residential medication management reviews on anticholinergic burden in aged care residents

Abstract

Objectives:

The primary objective of this study was to investigate the impact of Residential Medication Management Reviews (RMMRs) on anticholinergic burden quantified by seven anticholinergic risk scales.

Design:

Retrospective analysis.

Setting:

Accredited pharmacists conducted RMMRs in aged-care facilities (ACFs) in Sydney, Australia.

Participants:

RMMRs pertained to 814 residents aged 65 years or older.

Measurements:

Anticholinergic burden was quantified using seven scales at baseline, after pharmacists’ recommendations and after the actual GP uptake of pharmacists’ recommendations. Change in the anticholinergic burden was measured using the Wilcoxon sign rank test.

Results:

At baseline, depending on the scale used to estimate the anticholinergic burden, between 36% and 67% of patients were prescribed at least one regular anticholinergic medication (ACM). Anticholinergic burden scores were significantly (p < 0.001) lower after pharmacists’ recommendations as determined by each of the seven scales. The reduction in anticholinergic burden was also significant (p < 0.001) after GPs’ acceptance of the pharmacists’ recommendations according to all scales with the exception of one scale which reached borderline significance (p = 0.052).

Conclusion:

Despite the limitations of the retrospective design and differences in the estimation of anticholinergic burden, this is the first study to demonstrate that RMMRs are effective in reducing ACM prescribing in ACF residents, using a range of measures of anticholinergic burden. Future studies should focus on whether a decrease in anticholinergic burden will translate into improvement in clinical outcomes.

Keywords: :

• Aged-care facilities
• Anticholinergic burden
• Medication reviews
• Pharmacists

Transparency

Declaration of funding

There was no funding for this study.

Author contributions: All authors had access to the data and can take responsibility for the integrity of the data and the accuracy of the data analysis. P.E.M. analyzed and interpreted the data, and drafted the manuscript. R.L.C., C.M.C., G.M.P. and P.S.N. made substantial contribution to the study conception, data gathering, interpretation and critical revision of the manuscript. P.J.H. provided critical feedback on the manuscript. All authors approved the final version of the manuscript before submission.

Declaration of financial/other relationships

P.S.N. has disclosed that he is a former employee of Meditrax. P.J.H. has disclosed that he is a consultant for Meditrax. P.E.M., G.M.P., C.M.C., and R.L.C. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors acknowledge Meditrax Pty Ltd for providing access to the de-identified medication reviews analyzed in this study.