Deprescribing anticholinergics in primary care older adults: Experience from two models and impact on a continuous measure of exposure

BACKGROUND: Deprescribing interventions delivered through the electronic medical record have not significantly reduced the use of high‐risk anticholinergics in prior trials. Pharmacists have been identified as ideal practitioners to conduct deprescribing; however, little experience beyond collaborative consult models has been published. OBJECTIVE: To evaluate the impact of two pilot pharmacist‐based advanced practice models nested within primary care. METHODS: Pilot studies of a collaborative clinic‐based pharmacist deprescribing intervention and a telephone‐based pharmacist deprescribing intervention were conducted. Patients receiving the clinic‐based pharmacy model were aged 55 years and older and referred for deprescribing at a specialty clinic. Patients receiving the telephone‐based pharmacy model were aged 65 years and older and called by a clinical pharmacist for deprescribing without referral. Deprescribing was defined as a discontinuation or dose reduction reported either in clinical records or through self‐reporting. RESULTS: The 18 patients receiving clinic‐based deprescribing had a mean age of 68 years and 78% were female. Among 24 medications deemed eligible for deprescribing, 23 (96%) were deprescribed. The clinic‐based deprescribing model resulted in a 93% reduction in median annualized total standardized dose (TSD), 56% lowered their annualized exposure below a cognitive risk threshold, and 4 (17%) of medications were represcribed within 6 months. The 24 patients receiving telephone‐based deprescribing had a mean age of 73 years and 92% were female. Among 24 medications deemed eligible for deprescribing, 12 (50%) were deprescribed. There was no change in the median annualized TSD, the annualized TSD was lowered below a cognitive risk threshold in 46%, and no medications were represcribed within 6 months. Few withdrawal symptoms or adverse events were reported in both groups. CONCLUSIONS: Pharmacist‐based deprescribing successfully reduced exposure to high‐risk anticholinergics in primary care older adults, yet further work is needed to understand the impact on clinical outcomes.