Polypharmacy and anticholinergic burden in hospitalized older patients: The role of medication recognition and reconciliation in therapeutic deprescribing.

Abstract

Introduction: Polypharmacy is a crucial issue in the older population. Hospitalization provides an opportunity for medication review but can also reveal new clinical issues that require further prescriptions. Informatic systems for medication recognition and reconciliation (MRR) can assist physicians in the care process, especially at hospital discharge. This study aimed to assess whether implementation of an electronic MRR tool in an acute geriatric ward was associated with: 1) changes in medication count and anticholinergic cognitive burden from hospital admission to discharge; and 2) emergency department accesses, rehospitalizations, and mortality over a six-month follow-up.

Methods: This observational retrospective study involved 382 patients consecutively admitted to the Geriatric Unit of the Padua University Hospital from January 1 to December 31, 2017, with available data on medications taken before admission and prescribed at discharge. Two groups were considered: 247 patients admitted before (pre-MRR) and 135 after (post-MRR) the implementation of an electronic MRR tool (July 2017). For each patient, data on health, functional and cognitive status, medications, and total anticholinergic cognitive burden (ACB) at admission and discharge were collected.

Results: The study population had an average age of 86.5 years, and 66.8% were females. The mean hospital stay was 12 days, and 26.1% of patients were re-hospitalized within 6 months of follow-up. At admission, more than 60% of the sample was taking ≥5 drugs. The prevalence of polypharmacy (≥5 drugs) and hyperpolypharmacy (≥10 drugs) was 48.2% and 15.4%, respectively, in the pre-MRR group, and 54.1% and 18.5% in the post-MRR group, with no significant differences between groups. A significant increase in the number of medications at discharge was observed in both groups, more markedly in the pre-MRR than in the post-MRR group (average change +1.44 vs +0.73 drugs, p=0.009). Considering ACB, the post-MRR group had a 46% reduced probability (OR=0.54, 95%CI: 0.33-0.87) of being prescribed drugs with anticholinergic burden at discharge.

Conclusions: Implementation of electronic MRR tools in acute geriatric wards may help improve the quality rather than the quantity of prescriptions at hospital discharge; however, it does not seem to be associated with medium-term clinical outcomes in older patients.