{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T02:42:19Z","timestamp":1783132939501,"version":"3.54.6"},"reference-count":33,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,6,19]],"date-time":"2023-06-19T00:00:00Z","timestamp":1687132800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006041","name":"InnovateUK Knowledge Transfer Partnership","doi-asserted-by":"publisher","award":["KTP011672"],"award-info":[{"award-number":["KTP011672"]}],"id":[{"id":"10.13039\/501100006041","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Ensuring that medicines are prescribed safely is fundamental to the role of healthcare professionals who need to be vigilant about the risks associated with drugs and their interactions with other medicines (polypharmacy). One aspect of preventative healthcare is to use artificial intelligence to identify patients at risk using big data analytics. This will improve patient outcomes by enabling pre-emptive changes to medication on the identified cohort before symptoms present. This paper presents a mean-shift clustering technique used to identify groups of patients at the highest risk of polypharmacy. A weighted anticholinergic risk score and a weighted drug interaction risk score were calculated for each of 300,000 patient records registered with a major regional UK-based healthcare provider. The two measures were input into the mean-shift clustering algorithm and this grouped patients into clusters reflecting different levels of polypharmaceutical risk. Firstly, the results showed that, for most of the data, the average scores are not correlated and, secondly, the high risk outliers have high scores for one measure but not for both. These suggest that any systematic recognition of high-risk groups should consider both anticholinergic and drug\u2013drug interaction risks to avoid missing high-risk patients. The technique was implemented in a healthcare management system and easily and automatically identifies groups at risk far faster than the manual inspection of patient records. This is much less labour-intensive for healthcare professionals who can focus their assessment only on patients within the high-risk group(s), enabling more timely clinical interventions where necessary.<\/jats:p>","DOI":"10.3390\/ijerph20126178","type":"journal-article","created":{"date-parts":[[2023,6,20]],"date-time":"2023-06-20T02:26:56Z","timestamp":1687228016000},"page":"6178","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Automated Detection of Patients at High Risk of Polypharmacy including Anticholinergic and Sedative Medications"],"prefix":"10.3390","volume":"20","author":[{"given":"Amirali","family":"Shirazibeheshti","sequence":"first","affiliation":[{"name":"AT Medics Ltd., London SW2 4QY, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alireza","family":"Ettefaghian","sequence":"additional","affiliation":[{"name":"AT Medics Ltd., London SW2 4QY, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farbod","family":"Khanizadeh","sequence":"additional","affiliation":[{"name":"Operation & Information Management, Aston Business School, Birmingham B4 7UP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5245-1194","authenticated-orcid":false,"given":"George","family":"Wilson","sequence":"additional","affiliation":[{"name":"School of Computing and Information Science, Anglia Ruskin University, Cambridge CB1 1PT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarek","family":"Radwan","sequence":"additional","affiliation":[{"name":"AT Medics Ltd., London SW2 4QY, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4706-324X","authenticated-orcid":false,"given":"Cristina","family":"Luca","sequence":"additional","affiliation":[{"name":"School of Computing and Information Science, Anglia Ruskin University, Cambridge CB1 1PT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1023\/A:1024896328720","article-title":"Therapy related hospital admission in patients on polypharmacy in Singapore: A pilot study","volume":"25","author":"Koh","year":"2003","journal-title":"Pharm. World Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1023\/A:1011909827909","article-title":"Polypharmacy among patients admitted to hospital with rheumatic diseases","volume":"23","author":"Viktil","year":"2001","journal-title":"Pharm. World Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1007\/s11096-017-0520-9","article-title":"Polypharmacy and potential drug\u2013drug interactions in emergency department patients in the Caribbean","volume":"39","author":"Dookeeram","year":"2017","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1007\/s11096-018-00780-5","article-title":"Polypharmacy in older patients at primary care units in Brazil","volume":"41","author":"Gomes","year":"2019","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1007\/s00508-020-01801-y","article-title":"Clinical pharmacist interventions in cardiovascular disease pharmacotherapy in elderly patients on excessive polypharmacy","volume":"133","author":"Stuhec","year":"2021","journal-title":"Wien Klin. Wochenschr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1007\/s11096-020-01028-x","article-title":"A scoping review of polypharmacy interventions in patients with stroke, heart disease and diabetes","volume":"42","author":"Lum","year":"2020","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1007\/s11096-017-0470-2","article-title":"The \u201ciatrogenic triad\u201d: Polypharmacy, drug\u2013drug interactions, and potentially inappropriate medications in older adults","volume":"39","author":"Novaes","year":"2017","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1007\/s11096-020-01191-1","article-title":"Opioid prescribing and risk of drug-opioid interactions in older discharged patients with polypharmacy in Australia","volume":"43","author":"Gebremichael","year":"2021","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e10214","DOI":"10.7748\/ns.2016.e10214","article-title":"Adverse drug reactions: Classification, susceptibility and reporting","volume":"30","author":"Kaufman","year":"2016","journal-title":"Nurs. Stand."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"189","DOI":"10.12968\/npre.2014.12.4.189","article-title":"Understanding adverse drug reactions: An overview","volume":"12","author":"Greener","year":"2014","journal-title":"Nurse Prescr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1136\/bmjqs-2019-010206","article-title":"Economic analysis of the prevalence and clinical and economic burden of medication error in England","volume":"30","author":"Elliott","year":"2021","journal-title":"BMJ Qual. Saf."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1177\/2042098615615472","article-title":"Predicting risk of adverse drug reactions in older adults","volume":"7","author":"Lavan","year":"2016","journal-title":"Ther. Adv. Drug Saf."},{"key":"ref_13","first-page":"D439","article-title":"Clinical medication reviews in elderly patients with polypharmacy: A cross-sectional study in Dutch community pharmacies","volume":"160","author":"Chau","year":"2016","journal-title":"Ned. Tijdschr. Geneeskd."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1007\/s11096-018-0663-3","article-title":"Assessment of polypharmacy in elderly patients by using data from dispensed medications in community pharmacies: Analysis of results by using different methods of estimation","volume":"40","author":"Chiapella","year":"2018","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1007\/s11096-018-0602-3","article-title":"Changes in medicine prescription following a medication review in older high-risk patients with polypharmacy","volume":"40","author":"Hurmuz","year":"2018","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s11096-018-0761-2","article-title":"The association between polypharmacy and late life deficits in cognitive, physical and emotional capability: A cohort study","volume":"41","author":"Khezrian","year":"2019","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1007\/s11096-015-0147-7","article-title":"Older peoples\u2019 attitudes regarding polypharmacy, statin use and willingness to have statins deprescribed in Australia","volume":"37","author":"Qi","year":"2015","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1007\/s11096-019-00784-9","article-title":"DEFEAT-polypharmacy: Deprescribing anticholinergic and sedative medicines feasibility trial in residential aged care facilities","volume":"41","author":"Ailabouni","year":"2019","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1007\/s11096-017-0554-z","article-title":"Inappropriate anticholinergic drugs prescriptions in older patients: Analysing a hospital database","volume":"40","author":"Ferret","year":"2018","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1007\/s11096-013-9793-9","article-title":"Prescription patterns of anticholinergic agents and their associated factors in Korean elderly patients with dementia","volume":"35","author":"Lee","year":"2013","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1007\/s11096-020-01117-x","article-title":"Size of the associations between anticholinergic burden tool scores and adverse outcomes in older patients","volume":"43","author":"Lavrador","year":"2021","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Pfistermeister, B., T\u00fcmena, T., Maas, R., and Fromm, M.F. (2017). Anticholinergic burden and cognitive function in a large German cohort of hospitalized geriatric patients. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0171353"},{"key":"ref_23","unstructured":"(2022, January 13). Aging Brain Care. Anticholinergic Cognitive Burden Scale. Available online: https:\/\/corumpharmacy.com\/wp-content\/uploads\/2020\/08\/Anticholinergic-cognitive-burden-scale.pdf."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Berdot, S., Bertrand, M., Dartigues, J.F., Fourrier, A., Tavernier, B., Ritchie, K., and Alp\u00e9rovitch, A. (2009). Inappropriate medication use and risk of falls\u2014A prospective study in a large community-dwelling elderly cohort. BMC Geriatr., 9.","DOI":"10.1186\/1471-2318-9-30"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Nguyen, O.K., Makam, A.N., and Halm, E.A. (2016). National use of safety-net clinics for primary care among adults with non-medicaid insurance in the United States. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0151610"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1007\/s11096-021-01328-w","article-title":"Patient values and preferences on polypharmacy and deprescribing: A scoping review","volume":"43","author":"Forest","year":"2021","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1007\/s11096-020-01172-4","article-title":"Clinical, economic, and organizational impact of pharmacists\u2019 interventions in a cognitive-behavioral unit in France","volume":"43","author":"Novais","year":"2021","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1177\/2042098618791371","article-title":"Principle of rational prescribing and deprescribing in older adults with multiple chronic conditions","volume":"9","author":"Ouellet","year":"2018","journal-title":"Ther. Adv. Drug Saf."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.neucom.2019.03.055","article-title":"A method for detecting high-frequency oscillations using semi-supervised k-means and mean shift clustering","volume":"350","author":"Du","year":"2019","journal-title":"Neurocomputing"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1109\/TMI.2009.2013850","article-title":"An adaptive mean-shift framework for MRI brain segmentation","volume":"28","author":"Mayer","year":"2009","journal-title":"IEEE Trans. Med. Imaging"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"804566","DOI":"10.3389\/fphar.2022.804566","article-title":"A machine learning-based risk warning platform for potentially inappropriate prescriptions for elderly patients with cardiovascular disease","volume":"13","author":"Xingwei","year":"2022","journal-title":"Front. Pharmacol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"104074","DOI":"10.1016\/j.jbi.2022.104074","article-title":"Decision-support systems for managing polypharmacy in the elderly: A scoping review","volume":"130","author":"Mouazer","year":"2022","journal-title":"J. Biomed. Inform."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1016\/j.sapharm.2020.02.010","article-title":"Tools to prioritize outpatients for pharmaceutical service: A scoping review","volume":"16","author":"Sousa","year":"2020","journal-title":"Res. Soc. Adm. Pharm."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/12\/6178\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:56:31Z","timestamp":1760126191000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/12\/6178"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,19]]},"references-count":33,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["ijerph20126178"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20126178","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,19]]}}}