Reducing the anticholinergic and sedative load in older patients on polypharmacy by pharmacist-led medication review

A randomised controlled single blind trial was conducted in 15 community pharmacies in the Northern Netherlands. 157 community-dwelling patients aged ≥65 years who used ≥5 medicines for ≥3 months, including at least one psycholeptic/psychoanaleptic medication and who had a DBI≥1 were recruited. The intervention was a medication review by the community pharmacist in collaboration with the patient's general practitioner and patient. The primary outcome was the proportion of patients whose DBI decreased by at least 0.5. Secondary outcomes included presence of anticholinergic/sedative side effects, falls, cognitive function, activities of daily living, quality of life, hospital admission and mortality. Data were collected at baseline and 3 months follow-up.

To evaluate if a pharmacist-led medication review is effective at reducing the anticholinergic/sedative load, as measured by the Drug Burden Index (DBI), and to assess its impact on patient outcomes including cognitive function, risk of falls, activities of daily living and quality of life.

Pharmacist-led medication review in collaboration with the GP and patient, focusing on reducing anticholinergic and sedative medication load.

Community pharmacists in collaboration with general practitioners

Community-dwelling patients aged ≥65 years using ≥5 medications for ≥3 months including at least one psycholeptic/psychoanaleptic medication and with a DBI≥1

Primary: DBI reduction ≥0.5; Secondary: anticholinergic/sedative side effects, falls, cognitive function, activities of daily living, quality of life, hospital admission, mortality