{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T00:24:56Z","timestamp":1768695896103,"version":"3.49.0"},"reference-count":30,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2022,7,28]],"date-time":"2022-07-28T00:00:00Z","timestamp":1658966400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100019233","name":"Tabula Rasa HealthCare","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019233","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Given associations with serious cognitive and physical adverse effects (e.g., dementia, falls), strong anticholinergics, like urinary antimuscarinics (UAMs), should be avoided in older adults. This feasibility study aimed to (1) evaluate the implementation rate of pharmacists' recommendations intended to de\u2010escalate UAMs, (2) quantify the change in overall anticholinergic dosing exposure from these recommendations, and (3) investigate factors that predict recommendation implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This was a retrospective, observational, before\u2010and\u2010after study. Pharmacists (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u200918) devised strategies to de\u2010escalate UAMs in 187 participants (mean age 72.4\u00a0\u00b1\u20099.4; 77.0% female; mean number of medications 12.9\u00a0\u00b1\u20094.6) of 35 Programs of All\u2010Inclusive Care for the Elderly (PACE). PACE prescribers (non\u2010physicians and physicians) determined whether to implement recommendations. Implementation was defined as a change in the prescription records consistent with the pharmacist's recommendation at 2\u2010, 4\u2010, 6\u2010, and 9\u2010months post\u2010recommendation. Anticholinergic dosing exposure was measured at each time point using standardized daily doses (SDD). Multivariable logistic regression was used to identify factors that predicted recommendation implementation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Across 9\u00a0months, recommendations were implemented in 118 out of 187 participants, yielding a 63.1% implementation rate. Of these, 77.1% (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u200991\/118) implemented by month 2. Implementers' mean overall anticholinergic SDD decreased 65.4% from baseline (baseline: 2.6 [95% CI: 2.2, 3.0] to month 9: 0.9 [95% CI: 0.6,1.2],\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u20090.001) whereas non\u2010implementers demonstrated no significant change (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u20090.52). Taking &lt;10 baseline medications (OR 2.75; 95% CI: 1.09, 7.61); baseline UAM SDD \u22652 (OR 2.20; 95% CI: 1.11, 4.44); uncomplicated recommendations (OR 3.38; 95% CI: 1.67\u20137.03); and baseline calcium channel blocker use (OR 2.19; 95% CI: 1.09, 4.52) predicted implementation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our high implementation rate indicates that pharmacists' recommendations to de\u2010escalate UAMs as a way to reduce overall anticholinergic exposure is feasible in medically complex, community\u2010dwelling older adults. Future research should investigate whether these recommendations benefit cognitive (e.g., delirium, dementia) and\/or physical functioning (e.g., falls).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.17965","type":"journal-article","created":{"date-parts":[[2022,7,28]],"date-time":"2022-07-28T08:18:35Z","timestamp":1658996315000},"page":"3230-3238","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Pharmacist\u2010driven interventions to de\u2010escalate urinary antimuscarinics in the Programs of All\u2010Inclusive Care for the Elderly"],"prefix":"10.1111","volume":"70","author":[{"given":"Meghan","family":"Ha","sequence":"first","affiliation":[{"name":"Office of Translational Research and Residency Programs (OTRRP), Tabula Rasa HealthCare, Inc.  Moorestown New Jersey USA"},{"name":"Wolters Kluwer  Franklin Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Furman","sequence":"additional","affiliation":[{"name":"Office of Translational Research and Residency Programs (OTRRP), Tabula Rasa HealthCare, Inc.  Moorestown New Jersey USA"},{"name":"Optum Care, Inc.  Eden Prairie Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2415-4664","authenticated-orcid":false,"given":"Sweilem B.","family":"Al Rihani","sequence":"additional","affiliation":[{"name":"Precision Pharmacotherapy Research &amp; Development Institute, Tabula Rasa HealthCare, Inc.  Orlando Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1399-6447","authenticated-orcid":false,"given":"Veronique","family":"Michaud","sequence":"additional","affiliation":[{"name":"Precision Pharmacotherapy Research &amp; Development Institute, Tabula Rasa HealthCare, Inc.  Orlando Florida USA"},{"name":"Faculty of Pharmacy, Universit\u00e9 de Montr\u00e9al, Pavillon Jean\u2010Coutu, 2940 Chemin de Polytechnique  QC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7978-9280","authenticated-orcid":false,"given":"Jacques","family":"Turgeon","sequence":"additional","affiliation":[{"name":"Precision Pharmacotherapy Research &amp; Development Institute, Tabula Rasa HealthCare, Inc.  Orlando Florida USA"},{"name":"Faculty of Pharmacy, Universit\u00e9 de Montr\u00e9al, Pavillon Jean\u2010Coutu, 2940 Chemin de Polytechnique  QC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6358-2288","authenticated-orcid":false,"given":"David L.","family":"Bankes","sequence":"additional","affiliation":[{"name":"Office of Translational Research and Residency Programs (OTRRP), Tabula Rasa HealthCare, Inc.  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