Tackling Problematic Polypharmacy with AnalyseRx: Deprescribing to Reduce Anticholinergic Burden
At FDB, we’re supporting primary care teams in aligning with the NHS national medicines optimisation priorities, one of which is to reduce problematic polypharmacy. Here, we spoke to Clinical Product Lead, Vicky Damani about the work we’ve done across our solution AnalyseRx to support clinicians in tackling problematic polypharmacy through deprescribing across their patient population. Vicky is a Pharmacist and Independent Prescriber with experience in Secondary care, Primary Care Commissioning, GP Practice and Care Homes.
Why is reducing anticholinergic burden so important?
The cumulative anticholinergic burden, prevalent in problematic polypharmacy, is notably associated with falls as well as poorer outcomes, especially in patients over 65 years and those with dementia. We now have an ageing population with multiple co-morbidities, which can present significant challenges for elderly patients managing a growing list of medications. This means it’s more important than ever to reduce the anticholinergic burden, thereby reducing the risk of adverse drug events and avoidable hospital admissions and improving quality of life.
How can primary care teams work to tackle this issue?
We know that a blanket approach to reviewing every patient on more than 10 medicines can be unrealistic given the limited capacity and rising demands facing the primary care workforce. That’s why processes that allow the rapid identification of patients who are more likely to experience harm or those on high-risk combinations of medicines can be a more effective way of prioritising those who have the most urgent need for intervention.
What processes can we focus on?
Structured medication reviews (SMRs) focusing on high-risk patients are some of the most effective interventions for mitigating high anticholinergic burden. Despite this, variability in clinical system searches and capacity from practice to practice means patients can often slip through the net. I know first-hand from my time in the Primary Care Medicines Optimisation Team as well as in practice that searches and reports are time-consuming to create and often don’t have all the patients and information required. Plus, patient lists can quickly become out of date, making it harder for a team or several practices across a PCN to collaborate effectively.
How can AnalyseRx help ensure patients don’t get missed?
As a team, we’ve used a combination of our own clinical experience and customer input to develop a solution that allows clinicians to easily identify patients across a population in need of medication reviews and de-prescribing in high-risk scenarios. AnalyseRx automatically surfaces two separate cohorts of patients with a high anticholinergic score, those aged 65 and over and those with increased vulnerabilities such as dementia, moderate to severe frailty or a history of falls.
You can then prioritise patients even further by adding filters such as age, drug count, total cumulative anticholinergic burden and last structured medication review date.
What happens next?
With a targeted list of patients in the most urgent need of review, primary care teams can benefit from a clear action list that refreshes automatically every day, so you know you’re working with up-to-date patient data.
What does this mean for clinicians?
We want practice teams to have more time for their patients and ICS Medicines Optimisation Teams to have more time identifying and tracking opportunities to improve population outcomes. Instead of building clinical system searches from scratch and spending hours refining and running complex reports or using calculators to identify medications which may be contributing to a high anticholinergic burden, they’ve got this information automatically within AnalyseRx, with the ability to coordinate next steps effectively across a single practice or a PCN. The feedback from Pharmacists and Pharmacy Technicians has been fantastic – they love the range of filters available, which allows them to identify high-priority patients and focus their limited resources where it’ll have maximum impact.
How does it benefit patients themselves?
We’ve already seen great examples of improved patient outcomes across our customers using AnalyseRx for polypharmacy reviews. In a sample of 538 patients reviewed across 76 practices, 147 had at least one medicine deprescribed. Many had opioids and antidepressants deprescribed, which have been called out as medicines most commonly involved in preventable deaths.
What’s more over half of those who had medicines deprescribed were patients with either dementia, moderate to severe frailty or a history of falls.
Learn More
If you’d like to know more about how AnalyseRx can support your team get in touch at contact@fdbhealth.com