Hanus Rebecca J.,Lisowe Kristina S.,Eickhoff Jens C.,Kieser Mara A.,Statz-Paynter Jamie L.,Zorek Joseph A., Evaluation of a pharmacist-led pilot service based on the anticholinergic risk scale, Journal of the American Pharmacists Association, Volume 56, Issue 5, 2016, Pages 555-561
PubMed link: https://www.ncbi.nlm.nih.gov/pubmed/27053078
| Methods | Study design: Prospective before-and-after study
Number of groups: 1 |
| Participants | Number of participants: 59
Age: 77 ± 9.3 Sex: 30 female (51%) Participants with dementia: Unclear Inclusion criteria: ≥60 years Seeing a primacy care physician within the next 2 weeks ≥3 hospital admissions/emergency department presentations in previous year ≥10 active medications Concomitant medicines: mean 19.6 ± 6.7 Country: US Setting: 2 medical clinics |
| Interventions | Medicine: Anticholinergic medications
Intervention: Pharmacist-led electronic health record-based medication list review occurred and a report of recommendations supplied to physicians Withdrawal schedule: Trial discontinuation, dose reduction, or alternative medication Tool used to identify target medicines: Anticholinergic risk scale-triggering medications |
| Outcomes | Rate of accepted deprescribing recommendations
Rate of accepted trial discontinuation recommendations Aggregate post-intervention anticholinergic risk scale score |
| Dates | Dates: Not described
Follow-up duration: 6 weeks |
| Funding sources | Nil reported |
| Notes |
Risk of bias table
| Bias | Authors’ judgment | Support for judgment |
| Random sequence generation (selection bias) | Low | Single arm study |
| Allocation concealment (selection bias) | High | Single arm study |
| Blinding of participants and personnel (performance bias) | High | The pharmacist conducted the medication review and determined the outcomes. Participant blinding not discussed. |
| Blinding of outcome assessment (detection bias) | High | The pharmacist conducted the medication review and determined the outcomes |
| Incomplete outcome data (attrition bias) | High | Missing data not addressed |
| Selective reporting (reporting bias) | High | No protocol or prespecified analysis plan discussed. |
| Confounding (non-randomized) | High | Some confounders reported on or included in analysis |
| Other bias | ||
| Selection bias | Representativeness of the exposed cohort | Somewhat representative of older people taking anticholinergic medications in the community |
| Selection of the non-exposed cohort | No non-exposed group | |
| Ascertainment of exposure | Records | |
| Demonstration that outcome of interest was not present at start of study | Yes | |
| Comparability bias | Comparability of cohorts on the basis of the design or analysis | No second cohort |
| Outcome bias | Assessment of outcome | Record |
| Was follow-up long enough for outcomes to occur | Yes | |
| Adequacy of follow-up of cohorts | No statement | |
Leave a Reply