Athagran Nakham

Introduction: Older patients are often exposed to medications with anticholinergic activity. Anticholinergic burden (ACB) from medicines is linked to adverse health outcomes. However, healthcare professionals’ familiarity with ACB remains poor, and there is a lack of research on knowledge, attitudes, or practices (KAPs) of ACB among Emergency department (ED) clinicians. Methods: A nationwide survey of ACB based on a pilot survey was developed using the KAP framework and assessed for face and content validity by ACB experts. It was distributed to ED physicians across the UK using REDCap through social media and professional networks. Results: Among the 108 ED physicians who responded, 54.6% (n = 59) were aware of the term ACB, but 54.2% (n = 32/59) of them were unable to describe it. Their mean scores for quantifying the ACB score and identifying side effects in older patients were 2.9 and 4.1 out of 10, respectively. 88.9% (n = 96) believed that ACB is an important consideration in older patients. 67.6% (n = 73) agreed that awareness of the consequences of prescribing anticholinergic medications to older patients is important. 50% (n = 54) emphasized the importance of being able to assess and quantify the ACB score. Of the 75 physicians who prescribed these medications, 40% (n = 30/75) were unaware of ACB. 38.7% (n = 29/75) rarely considered ACB, 30.7% (n = 23/75) never considered it, and only 1.3% (n = 1/75) always considered it. The majority of respondents (88.9%, n = 96) agreed that more education on ACB is needed in the ED. Conclusions: ED physicians in the UK have limited knowledge and awareness of ACB management and prescribing practices for older patients. However, they show positive attitudes towards their role in ACB management and a willingness to receive further education. The low response rate suggests that findings may reflect a motivated subset of clinicians. These results highlight the need for targeted education and further investigation into curricular coverage of prescribing safety and anticholinergic burden.

Introduction Older patients are often exposed to medications with anticholinergic activity. Anticholinergic burden (ACB) from medicines is linked to adverse health outcomes. However, healthcare professionals’ familiarity with ACB remains poor, and there is a lack of literature in knowledge, attitudes, or practices (KAP) of ACB among Emergency department (ED) clinicians. Methods A nationwide survey of ACB (using https://www.acbcalc.com) based on a pilot survey was developed using the KAP framework and assessed for face and content validity by ACB experts. It was distributed to ED physicians across the UK using REDCap through social media and professional networks. Results Among the 108 ED physicians who responded, 54.6% (n=59) were aware of the term ACB, but 54.2% (n=32/59) of them were unable to describe it. Their mean scores for quantifying the ACB score and identifying side effects in older patients were 2.9 and 4.1 out of 10, respectively. 88.9% (n=96) believed that ACB is an important consideration in older patients. 67.6% (n=73) agreed that awareness of the consequences of prescribing anticholinergic medications to older patients is important. 50% (n=54) emphasized the importance of being able to assess and quantify the ACB score. Of the 75 physicians who prescribed these medications, 40% (n=30/75) were unaware of ACB. 38.7% (n=29/75) rarely considered ACB, 30.7% (n=23/75) never considered it, and only 1.3% (n=1/75) always considered it. The majority of respondents (88.9%, n=96) agreed that more education on ACB is needed in the ED. Conclusion ED physicians in the UK have limited knowledge and awareness of ACB management and prescribing practices for older patients. However, they show positive attitudes towards their role in ACB management and a willingness to receive further education.

Background: Anticholinergic burden (ACB) from medications has been associated with adverse outcomes in older adults. Aim: The aim was to conduct a non-randomized feasibility study of an intervention to reduce the anticholinergic burden in older patients (REGENERATE) to inform a subsequent definitive trial. Methods: The development and evaluation of an ACB reduction intervention was guided by the Medical Research Council framework. Findings from preliminary studies, two systematic reviews, and two qualitative studies informed the design of a mixed-method feasibility study. The study was conducted in one UK primary care site. The clinical pharmacist identified and invited potentially eligible patients, reviewed their medications, and made recommendations to reduce the ACB as needed. Patients completed surveys at baseline and 6 and 12 weeks post-intervention. A purposive sample of patients and healthcare professionals was interviewed. Results: There was a response of 16/20; 14/16 attended the pharmacist-led consultation and completed the baseline questionnaire, and 13/14 completed both follow-up questionnaires. The sustainability of deprescribing was confirmed. The results suggest the potential of the intervention to reduce side effects from medications and improve quality of life (EQ-5D-5L). The interviews showed patients were happy with the study processes and the medication changes and were satisfied with the pharmacist’s consultation. Conclusions: This feasibility study demonstrated that a deprescribing/reducing ACB intervention in older adults is feasible in a primary care setting and may benefit patients. Well-designed RCTs and cost-effectiveness studies should be undertaken to confirm the benefits of ACB deprescribing in primary care settings.

Anticholinergic burden (ACB) from medications has been associated with adverse outcomes in older people. Aim: To conduct a non-randomised feasibility study of an intervention to Reduce anticholinerGic burdEN in oldER pATiEnts (REGENERATE) to inform a subsequent definitive trial. Methods: The development and evaluation of an ACB reduction intervention was guided by the Medical Research Council framework. Findings from preliminary studies, two systematic reviews and two qualitative studies informed the design of a mixed-method feasibility study. The study was conducted in one UK primary care site. The clinical pharmacist identified and invited potentially eligible patients, reviewed their medications and made recommendations to reduce the ACB as needed. Patients completed surveys at baseline, and 6- and 12- weeks post intervention. A purposive sample of patients and healthcare professionals was interviewed. Results: There was an 16/20 response; 14/16 attended the pharmacist led consultation and completed the baseline questionnaire and 13/14 completed both follow-up questionnaire. The sustainability of deprescribing was confirmed. The results suggest the potential of the intervention to reduce side effects from medications and improve quality of life (EQ-5D-5L). The interviews showed patients were happy with the study processes, and the medication changes, and were satisfied with the pharmacist’s consultation. Conclusions: This feasibility study demonstrated that a deprescribing/reducing ACB intervention in older people is feasible in a primary care setting and may benefit patients. Well-designed RCTs and cost-effectiveness studies should be undertaken to confirm the benefits of ACB deprescribing in primary care settings. Trial registration: ClinicalTrials.gov no. NCT04660838