Project overview
Background
It is estimated that between 33-47% of hospitalised older people are prescribed one or more medication with anticholinergic effects. Anticholinergic burden (ACB) – the accumulation of higher levels of exposure to one or more anticholinergic medications- is associated with physical impairment, increased risk of falls, cognitive impairment, delirium, dementia, and all-cause mortality in older people. Deprescribing anticholinergic medications is key to improve health outcomes of older people, and hospital admission could be ideal for deprescribing because it offers an opportunity to identify and prioritise patients at high-risk of anticholinergic burden. However, lack of collaborative working, low confidence, system resources and organisation of care are reported barriers for deprescribing anticholinergic burden in routine practice. In addition, most deprescribing studies focused on community or nursing home settings, and little has been done in a hospital setting.
Aims and objectives
The aim is to test the feasibility and acceptability of using a digital tool to identify and reduce medications with a high anticholinergic burden among hospitalised older patients. The research team has recently worked with a software company (TRISCRIBE) to develop and validate a digital tool with an embedded evidence-based database, that quantifies the overall anticholinergic burden score for each patient, listing the individual medicines contributing to that score and their individualised drug score.
The objectives are to
• Assess the feasibility of using and integrating the TRISCRIBE tool in the workflow of the clinical team to reduce anticholinergic burden scores.
• Examine the acceptability of the intervention to patients and carers as well as healthcare professionals involved in delivering the intervention.
• Determine the potential effects of the intervention on medication- and patient-related outcomes using pre-post quasi study design.
• Determine the feasibility of collecting resource use and identify key resource items that will be important to capture in the future trial.
Methods
A feasibility study using a pre-post study design will be conducted with 50 older patients admitted to Medicine for Older People (MOP) wards at the University Hospital Southampton. Patients will receive a collaborative deprescribing intervention including: 1) pharmacist-led identification of patients using TRISCRIBE digital tool and highlighting anticholinergics medications on their clinical notes for targeted deprescribing, 2) doctor-led medication review to stop, reduce dose or switch to safer alternatives based on individual patient needs, and 3) highlighting and communicating medication changes to GP on discharge summaries.
Feasibility of the intervention will be determined by collecting data on recruitment rates, follow-up rates, time and resources needed. Baseline and 3months follow-up data will be collected on medication-related outcomes (number of medications, anticholinergic burden scores), health-related outcomes (function, frailty status, cognition, quality of life, delirium), costs, and adverse events (e.g., hospitalisation) to determine the effects and safety of the intervention. Acceptability of the intervention will be determined through qualitative interviews with a purposive sample of patients and their carers as well as healthcare professionals involved in delivering the intervention.
Impact and dissemination
An inclusive dissemination plan will be co-developed in collaboration with our stakeholders and PPIE group to identify who to engage with and how best to engage them to ensure accessible and inclusive outputs. The findings will be shared with public, health professionals, researchers and policymakers through plain English summaries, social media, policy briefing documents, scientific papers, conferences and other meetings.
It is estimated that between 33-47% of hospitalised older people are prescribed one or more medication with anticholinergic effects. Anticholinergic burden (ACB) – the accumulation of higher levels of exposure to one or more anticholinergic medications- is associated with physical impairment, increased risk of falls, cognitive impairment, delirium, dementia, and all-cause mortality in older people. Deprescribing anticholinergic medications is key to improve health outcomes of older people, and hospital admission could be ideal for deprescribing because it offers an opportunity to identify and prioritise patients at high-risk of anticholinergic burden. However, lack of collaborative working, low confidence, system resources and organisation of care are reported barriers for deprescribing anticholinergic burden in routine practice. In addition, most deprescribing studies focused on community or nursing home settings, and little has been done in a hospital setting.
Aims and objectives
The aim is to test the feasibility and acceptability of using a digital tool to identify and reduce medications with a high anticholinergic burden among hospitalised older patients. The research team has recently worked with a software company (TRISCRIBE) to develop and validate a digital tool with an embedded evidence-based database, that quantifies the overall anticholinergic burden score for each patient, listing the individual medicines contributing to that score and their individualised drug score.
The objectives are to
• Assess the feasibility of using and integrating the TRISCRIBE tool in the workflow of the clinical team to reduce anticholinergic burden scores.
• Examine the acceptability of the intervention to patients and carers as well as healthcare professionals involved in delivering the intervention.
• Determine the potential effects of the intervention on medication- and patient-related outcomes using pre-post quasi study design.
• Determine the feasibility of collecting resource use and identify key resource items that will be important to capture in the future trial.
Methods
A feasibility study using a pre-post study design will be conducted with 50 older patients admitted to Medicine for Older People (MOP) wards at the University Hospital Southampton. Patients will receive a collaborative deprescribing intervention including: 1) pharmacist-led identification of patients using TRISCRIBE digital tool and highlighting anticholinergics medications on their clinical notes for targeted deprescribing, 2) doctor-led medication review to stop, reduce dose or switch to safer alternatives based on individual patient needs, and 3) highlighting and communicating medication changes to GP on discharge summaries.
Feasibility of the intervention will be determined by collecting data on recruitment rates, follow-up rates, time and resources needed. Baseline and 3months follow-up data will be collected on medication-related outcomes (number of medications, anticholinergic burden scores), health-related outcomes (function, frailty status, cognition, quality of life, delirium), costs, and adverse events (e.g., hospitalisation) to determine the effects and safety of the intervention. Acceptability of the intervention will be determined through qualitative interviews with a purposive sample of patients and their carers as well as healthcare professionals involved in delivering the intervention.
Impact and dissemination
An inclusive dissemination plan will be co-developed in collaboration with our stakeholders and PPIE group to identify who to engage with and how best to engage them to ensure accessible and inclusive outputs. The findings will be shared with public, health professionals, researchers and policymakers through plain English summaries, social media, policy briefing documents, scientific papers, conferences and other meetings.
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