Evaluation of a pharmacist-led pilot service based on the anticholinergic risk scale

This pilot service evaluated medical records of patients aged 60+ with high health care utilization and polypharmacy. Anticholinergic Risk Scale (ARS) scores were calculated, and medication therapy recommendations were sent electronically to primary care physicians for patients with ARS >3. Post-visit outcomes were recorded. The project was conducted at two medical clinics within Dean Health System using a standardized algorithm and decision support tools.

To determine primary care physician acceptance rates of electronic medication therapy recommendations based on anticholinergic burden for high-risk elderly patients, and to evaluate potential associations between recommendation acceptance and patient-provider characteristics.

Pharmacist-led electronic health record-based medication therapy recommendation service targeting anticholinergic burden.

Pharmacists

Patients aged 60+, with ≥3 hospitalizations or ED visits in the past year, ≥10 active medications, and upcoming PCP visit.

Physician acceptance rates of recommendations, changes in ARS scores, associations between patient/provider characteristics and acceptance.