Embedding the Anticholinergic Burden score and deprescribing into a collaborative community and secondary care frailty clinic

Background

This clinical improvement project took place at a community frailty clinic. The primary and secondary care collaboration clinic comprised of an MDT including a physiotherapist, HCA, social prescriber, consultant geriatrician and GPwER in frailty. Older adults with a Rockwood score of 5 or more were assessed using the CGA domains. 

Introduction

Anticholinergic burden (ACB) is defined as the cumulative effect of taking one or more medications with anticholinergic effects (e.g. opioids, antimuscarinics and trycyclics). ACB score is a method of quantifying this. Higher ACB scores (3+) are associated with cognitive decline, risk of admissions with falls/ fractures and increased mortality.

The aim of the study was to quantify reduction in ACB score following structured medication review. The goal was to determine whether the frailty clinic was an appropriate setting for this.

Methods

Over a 5-month period the consultant geriatrician and GPwER calculated each patient’s ACB score. A medication reconciliation within their appointment facilitated deprescribing of high-risk medications. The HCA recorded ACB scores for all patients before and after medication review.

Results

54 patients attended the clinic. 18 patients had an initial ACB score of 0. The remaining 36 patients, had an ACB score of at least 1. Their mean reduction in ACB score was 1.2 points. Most pertinently, of the 19 patients with ACB scores of 3 or more, 12 left the clinic with a lower score and mean reduction was 2.1 points. One patient achieved a drop in score from 9 to 0.  Only 2 patients left with increased anticholinergic burden (in both cases, only increasin by 1 point).

Conclusions

Embedding the ACB score into the frailty clinics medication reviews were easily-achieved. This process is documented in clinic proformas, letters and the MDT discussion. This would be simple to transfer to similar settings.