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Researchers developed the Anticholinergic Medication Index to help clinicians identify older patients whose combination of medicines may raise their risk of delirium or falls. Its clinical decision-support version is live in two NHS trusts, while further pilots examine whether it can be used more widely. The source does not report evidence that the tool has already reduced falls or delirium.
Researchers have developed an electronic health record tool that helps NHS clinicians identify people aged 65 and older who may face higher risks of delirium or falls linked to medicines with anticholinergic effects. The tool is live in two NHS trusts, and further hospital pilots are examining whether it can be used more widely; the research report does not establish that it has already prevented falls or delirium.
The Anticholinergic Medication Index, or ACMI, assigns a score based on a patient’s anticholinergic medication burden and the risks of delirium or falls. Anticholinergic effects can occur in medicines prescribed for different conditions, including drugs for which these effects are not the main purpose. When a person takes several such medicines, their combined burden may be relevant to a medication review.
In a pilot in Bradford general practices, the system automatically generated lists of patients aged 65 or older, showing each person’s ACMI score, the medicines contributing to it and their predicted one-year risk of a fall or delirium. Researchers said that compiling this information manually patient by patient would otherwise be needed to help pharmacists prioritize reviews.
A related clinical decision-support system, called ACMICS, has been embedded in electronic patient records and is now in use at two NHS trusts. It can appear at different points in clinical workflows and recalculate when an anticholinergic medicine is started or stopped. The team has also produced a technical specification to help other organizations develop an equivalent system.
Automating Medication Risk Reviews
The tool addresses a practical problem: clinicians may need to review many medicines for patients with multiple health conditions, but identifying which patients could benefit most can take time. By gathering medication information and calculating a score within the existing patient record system, ACMI may help teams focus review efforts on patients flagged as higher risk.
That could matter for older people because falls and delirium can have serious effects on health and independence, and may lead to additional care needs. The source also describes other possible adverse effects associated with anticholinergic burden, including dry mouth, constipation and difficulty emptying the bladder. However, the reported deployment and pilots show that the system is being used and assessed; they do not by themselves show that patient outcomes have improved.
The approach may also help make research findings actionable in routine care. A score that is calculated automatically and refreshed when prescriptions change could give clinicians a more timely prompt than a separate manual assessment, while leaving prescribing decisions to health professionals.
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How Researchers Built the Index
The team included researchers from the University of Leeds, University of Liverpool and Bradford Institute for Health Research. Their study, published in BMJ Medicine, developed and externally validated the risk-prediction model using health records for nearly 750,000 adults over 65.
For development, the researchers used de-identified linked primary and secondary care records from Connected West Yorkshire. They then tested the index against a large national dataset in Wales held by the Secure Anonymized Information Linkage, or SAIL, Databank. This testing is distinct from proving that use of the tool changes clinical outcomes.
Lead author Dr. Kate Best said that about 50% of older adults in the UK are prescribed at least one anticholinergic medicine annually. She noted that such a medicine may sometimes be the best treatment, while the combined burden can accumulate when people take several medicines with these effects.
“Approximately 50% of older adults are prescribed at least one anticholinergic medication annually in the U.K.”
— Dr. Kate Best, associate professor of applied statistics at the University of Leeds and the study’s first author
Patient Outcomes Still Need Testing
The source does not give figures showing whether ACMI use has reduced falls, delirium, hospital admissions or other harms. A risk score identifies people for consideration; it does not show that a particular medicine caused an individual patient’s symptoms, nor does it prescribe a change. Clinicians must weigh the risks and benefits of treatment for each patient.
It is also not clear from the report how many patients have been assessed through the live systems, how clinicians responded to the alerts, or how the tool performs across different NHS settings. The researchers are piloting ACMI on geriatric medicine and hip-fracture wards to examine the feasibility of wider secondary-care use. Findings from those pilots and any evaluation of clinical outcomes have not been provided in the source material.
Hospital Pilots Will Inform Rollout
The research team is testing the tool in several geriatric medicine and orthopedic hip-fracture wards to assess whether wider deployment in secondary care is feasible. The technical specification may also support other health organizations seeking to build an equivalent tool into their own electronic record systems.
Further information is needed on how the pilots affect prescribing and whether they improve patient outcomes. Until such results are reported, the confirmed development is that ACMI has been built, tested on large datasets and put into clinical use at two trusts—not that it has been shown to cut falls or delirium.
Key Questions
What is the Anticholinergic Medication Index?
ACMI is a score designed to help clinicians identify older patients whose anticholinergic medication burden may be associated with a higher risk of delirium or falls. It uses information about the medicines a patient takes.
Is the tool already being used by the NHS?
The related clinical decision-support system, ACMICS, is reported to be live and in use at two NHS trusts. Additional pilots are underway in hospital wards.
Has the tool been shown to prevent falls or delirium?
The source reports development, validation and implementation, but does not provide evidence that the tool has already reduced falls or delirium. Further evaluation is needed to establish its effect on patient outcomes.
Does a high score mean a patient should stop a medicine?
No. The score is intended to help prioritize a professional medication review, not to direct patients to stop treatment. Prescribing decisions require consideration of the patient’s conditions, benefits of treatment and possible risks.
Source: medicalxpress.com
