The concurrent use of multiple anticholinergic (ACH) medications (Poly-ACH) can be reduced through physician education, clinical decision support, deprescribing protocols, and designated pharmacist/physician champions, a study at Kaiser Permanente Southern California (KPSC) shows. “As older adults are more susceptible to adverse drug reactions, superior prescribing performance must include when to avoid the initiation of medications, when to decrease the dose, and when to deprescribe,” the authors conclude.
Prescribing of ACH medications in KPSC had been relatively consistent from 2006 to 2015. Working through chiefs of services in 12 geographic areas of KPSC, interventions began in 2018 to reduce ACH prescribing safely and appropriately. These included protocols to not initiate, discontinue, not refill, or convert medications to safer alternatives; lectures and handouts; best practice alerts to assist decision support within the electronic medical records; and designated pharmacist champions partnered with physician champions in each KPSC subregion.
“Using 2018 as the baseline for KPSC, a reduction in patients on Poly-ACH medications was shown in the CMS measure (publicly reported as a percentage) from 2018 to 2021,” the authors write. “5.63% of patients received Poly-ACH agents in 2018 compared with 4.42% in 2019, 4.28% in 2020, and 3.79% in 2021. Significantly, in 2019, there were 6,448 fewer older patients on at least one ACH drug (ie denominator) compared with 2018, and 1,720 fewer patients in 2020 compared with 2019, and 1,215 fewer patients in 2021 compared with 2020. KPSC Medicare membership also increased over this time-period demonstrating that the observed reduction in Poly-ACH patients was not related to any decline in KPSC Medicare membership.”