A Pilot Study to Reduce Inappropriate Anticholinergic Prescribing in the Elderly
| Status: | Completed |
|---|---|
| Conditions: | Alzheimer Disease |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 65 - Any |
| Updated: | 3/31/2019 |
| Start Date: | September 2014 |
| End Date: | November 20, 2015 |
Evaluation of a Patient-Centered Medication Therapy Management Intervention to Reduce Inappropriate Anticholinergic Prescribing in the Elderly
This will be an eight-week, prospective, placebo-controlled, randomized trial to evaluate a
patient-centered team (pharmacist-physician) intervention to improve medication
appropriateness and reduce the use of inappropriate anticholinergic medications in elderly
patients enrolled in the Sanders-Brown Alzheimer's Disease Center (ADC) cohort.
patient-centered team (pharmacist-physician) intervention to improve medication
appropriateness and reduce the use of inappropriate anticholinergic medications in elderly
patients enrolled in the Sanders-Brown Alzheimer's Disease Center (ADC) cohort.
Screening: Patients seen in the Sanders-Brown clinic as part of the ADC cohort will be
screened for eligibility in our study by the ADC study coordinator and the licensed
prescriber involved in the scheduled ADC visit.
Enrollment: If the patient is considered eligible based on the screening, the study
coordinator will introduce our study to the potential participant and will answer questions
the patient might have. If the patient is interested, the study coordinator will obtain the
informed consent and will proceed with the study related activities. Medication information
and SF-36 are collected as part of the ADC cohort data collection; therefore, to reduce the
burden on the participant, we are planning to work with the ADC team and use these data as
baseline information for our study. For participants randomized to the intervention group,
the two onsite study visits will be scheduled- the intervention visit will be planned within
a week after enrollment and the end of study visit will be scheduled 8 weeks after
enrollment. Participants randomized to the control group will have their end of study visit
scheduled 8 weeks post-enrollment.
After enrollment, the study pharmacist will perform medication therapy management (MTM) to
review all medications from the list provided by the patient. The pharmacist will identify
any anticholinergic medication, will determine the medication appropriateness index and will
prepare a report to include information on potential inappropriate medications to make
recommendations for treatment discontinuation or change as considered appropriate. For
participants included in the intervention group, the pharmacist will discuss the
recommendations with one of the licensed prescribers before the scheduled visit by the
participant. Final recommendations on discontinuing or changing inappropriate medications
will be made by medical staff. In the case of medication necessity, safer alternatives will
be sought and will be included in the proposed plan to be discussed with the patient assigned
to the intervention arm.
Intervention visit: Those included in the intervention group will undergo an educational
session with the study pharmacist and one of the licensed prescribers from Sanders-Brown to
discuss recommended changes in their treatment plan. If changes in medications are indicated
by the pharmacist-prescriber team, and accepted by the patient, new prescriptions will be
provided and a letter will be sent to the primary care physicians detailing the changes made
and the rationale behind such changes. Sending a letter to the primary care provider to
inform of medication changes by the specialist is considered standard of care.
Both intervention and control group will receive a generic brochure that describes medication
safety in the elderly in general terms.
End of study visit: At this visit, which will be scheduled eight weeks after enrollment, both
the intervention and control group will complete SF-36 and will update the data on their
current medication. They will also complete a questionnaire asking about their experience as
part of the study.
Post-visit evaluation: The study pharmacist will review the new medication list and the
follow-up MAI will be calculated through a similar procedure as detailed above.
Post-visit follow-up: All of the study participants will receive a thank you letter and will
be informed of the availability of the study team to further discuss their medication plan
and of the ADC prescribers to continue to support their ongoing care. The thank you letter
will also include a check to compensate participants for being part of our study.
Intervention The intervention will be based on the pharmacist-physician team drug review. For
patients randomized to the intervention group, the clinical pharmacist performed drug reviews
will guide a revised medication plan that will be discussed with the patient. Specifically,
the proposed plan will attempt to recommend discontinuation or replacement of any
inappropriate drug with anticholinergic properties, with safer drug alternatives (i.e., with
less or no anticholinergic activity). When drug alternatives are unavailable, reduction in
dosage will be attempted to reduce the anticholinergic burden. As part of their routine
clinical duties and care for ADC research participants, the prescribing team (ADC licensed
practitioners) will make the recommendations to the patient, while the study pharmacist will
be responsible for recommendations and provision of information to educate the patient about
medication safety and the importance of patient involvement in medication awareness and
oversight. Appropriate changes will be determined and carried out by the licensed prescriber
and a letter will be sent informing the primary care physician of medication changes and
rationale for such changes.
screened for eligibility in our study by the ADC study coordinator and the licensed
prescriber involved in the scheduled ADC visit.
Enrollment: If the patient is considered eligible based on the screening, the study
coordinator will introduce our study to the potential participant and will answer questions
the patient might have. If the patient is interested, the study coordinator will obtain the
informed consent and will proceed with the study related activities. Medication information
and SF-36 are collected as part of the ADC cohort data collection; therefore, to reduce the
burden on the participant, we are planning to work with the ADC team and use these data as
baseline information for our study. For participants randomized to the intervention group,
the two onsite study visits will be scheduled- the intervention visit will be planned within
a week after enrollment and the end of study visit will be scheduled 8 weeks after
enrollment. Participants randomized to the control group will have their end of study visit
scheduled 8 weeks post-enrollment.
After enrollment, the study pharmacist will perform medication therapy management (MTM) to
review all medications from the list provided by the patient. The pharmacist will identify
any anticholinergic medication, will determine the medication appropriateness index and will
prepare a report to include information on potential inappropriate medications to make
recommendations for treatment discontinuation or change as considered appropriate. For
participants included in the intervention group, the pharmacist will discuss the
recommendations with one of the licensed prescribers before the scheduled visit by the
participant. Final recommendations on discontinuing or changing inappropriate medications
will be made by medical staff. In the case of medication necessity, safer alternatives will
be sought and will be included in the proposed plan to be discussed with the patient assigned
to the intervention arm.
Intervention visit: Those included in the intervention group will undergo an educational
session with the study pharmacist and one of the licensed prescribers from Sanders-Brown to
discuss recommended changes in their treatment plan. If changes in medications are indicated
by the pharmacist-prescriber team, and accepted by the patient, new prescriptions will be
provided and a letter will be sent to the primary care physicians detailing the changes made
and the rationale behind such changes. Sending a letter to the primary care provider to
inform of medication changes by the specialist is considered standard of care.
Both intervention and control group will receive a generic brochure that describes medication
safety in the elderly in general terms.
End of study visit: At this visit, which will be scheduled eight weeks after enrollment, both
the intervention and control group will complete SF-36 and will update the data on their
current medication. They will also complete a questionnaire asking about their experience as
part of the study.
Post-visit evaluation: The study pharmacist will review the new medication list and the
follow-up MAI will be calculated through a similar procedure as detailed above.
Post-visit follow-up: All of the study participants will receive a thank you letter and will
be informed of the availability of the study team to further discuss their medication plan
and of the ADC prescribers to continue to support their ongoing care. The thank you letter
will also include a check to compensate participants for being part of our study.
Intervention The intervention will be based on the pharmacist-physician team drug review. For
patients randomized to the intervention group, the clinical pharmacist performed drug reviews
will guide a revised medication plan that will be discussed with the patient. Specifically,
the proposed plan will attempt to recommend discontinuation or replacement of any
inappropriate drug with anticholinergic properties, with safer drug alternatives (i.e., with
less or no anticholinergic activity). When drug alternatives are unavailable, reduction in
dosage will be attempted to reduce the anticholinergic burden. As part of their routine
clinical duties and care for ADC research participants, the prescribing team (ADC licensed
practitioners) will make the recommendations to the patient, while the study pharmacist will
be responsible for recommendations and provision of information to educate the patient about
medication safety and the importance of patient involvement in medication awareness and
oversight. Appropriate changes will be determined and carried out by the licensed prescriber
and a letter will be sent informing the primary care physician of medication changes and
rationale for such changes.
Inclusion Criteria:
- Enrolled at the Sander's Brown Center on Aging Alzheimer Disease Center
- Are 65 years of age or older
- Are taking at least one anticholinergic medication
- No cognitive impairment or mild cognitive impairment
Exclusion Criteria:
- Are younger than 65 years of age
- Have moderate to severe cognitive impairment
- Live in a long-term care facility
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