WS8: Providing care in complex polypharmacy, are there tools which help?

Maire O'Dwyer, School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin
Martin Henman, School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin


People with intellectual disabilities (ID) comprise 1-3% of the population and have complex and varied pharmaceutical care needs which requires personalised care. Estimates suggest that people with ID have up to 2.5 times the health problems of the general population, with higher levels of neurological and mental health conditions. As a result central nervous system (CNS) polypharmacy is commonplace and adults with ID are likely to have a high burden of medicines with sedative and anticholinergic effects and patients with dementia often have a similar profile. Exposure to these medicines has been associated with falls, frailty, sedation, constipation and may have a significant negative impact on quality of life. There have been no specific prescribing guidelines developed for people with ID and limited guidelines for those with dementia. These complex and vulnerable patients are cared for in institutional and increasingly, in community settings, where primary care professionals will need support in order to provide appropriate pharmaceutical care.
A number of different tools may be useful in quantifying the burden of medicines with anticholinergic and sedative medicines in older adults, including the Drug Burden Index (DBI) and Anticholinergic Cognitive Burden (ACB) Scale. These tools have also been developed into online applications. Their application could guide recommendations around medicines review and optimisation. The application of these tools to complex cases can facilitate assessment of risk and medication review

Target audience:

To provide participants with the opportunity to identify specific pharmaceutical care needs through classification of medicines as anticholinergic/sedative using the tools and application of two evidence-based tools quantifying sedative and anticholinergic burden (the Drug Burden Index Tool and Anticholinergic Cognitive Burden scale) to complex cases drawn from a longitudinal cohort study of adults with ID. Participants will discuss and identify how these tools may be utilised both in research and in clinical pharmacy practice to provide personalised care for vulnerable populations, such as adults with ID or adults with dementia.

Learning Objectives:

On completion of this workshop partcipants will be able to:
1. Identify the specific pharmaceutical care needs of adults with intellectual disability and the need for personalised pharmaceutical care in this population
2. Experience the application of the tools using both simple and complex patient cases
3. Critically appraise the tools used to quality anticholinergic and/or sedative burden ( the Anticholinergic Cognititive Burden Scale and the Drug Burden Index)
4. Plan for application of the tools in research and practice areas to improve personalised care for adults with ID or other vulnerable populations, such as adults with dementia
5. Consider the role of the pharmacists and the use of these tools to optimise anticholinergic and sedative medicine use
6. Identify potential research collaborations in application of these tools

Content and Structure:

This workshop will be interactive and consist of an introduction outlining the specific pharmaceutical care needs for adults with ID, the two risk assessment tools (the Anticholinergic Cognitive Burden Scale (ACB) and Drug Burden Index (DBI) tool) . The main part of the workshop will involve the application and appraisal of the tools on patient cases in small groups. The moderators will draw on their experience in pharmacy education, pharmacy practice and research to encourage interaction and participation through structured group activities.

Introduction and Presentation: 0-20 minutes: Introduction to pharmaeutical care needs of adults with ID, Drug Burden Index and Anticholinergic Cognitive Burden Scale, including examples of their utilisation in research and practice
Small group Task 1 : 20-55 minutes
After an explanation of the task groups will consider the rating of particular drug’s anticholinergic and sedative properties and then apply both tools (ACB and DBI) to specifically designed patient cases.
Groups will feedback their classification of the drug and their first impressions of the ease of use of the two tools. The groups will highlight practical issues, barriers and facilitators with using the tool in practice and/or research and classifying medicines as anticholinergic/sedative through use of the tools. The facilitators will moderate a discussion about the cases and the application of the tools.
Small group Task 2 : 55 - 100 minutes
Following an explanation of the task and using more complex cases, groups will apply both tools and calculate the values of the Anticholinergic Burden and the Drug Burden Index. They will evaluate the need for, and the risks associated with the drugs in the cases and the contribution that the tools make to this evaluation.
Groups will feedback their results and the outcome of their evaluations. Participants will share practical experience from different countried and settings with use of the tools. The facilitators will moderate a discussion about the cases and the application of the tools and relate the points raised to the published evidence of the strengths and limitations of the tools.
Reflection and Summary: 100-120 minutes:
The facilitators will reflect on the workshop outcomes, summarise the feedback and offer their perspective on the key learnings. The moderators will also look at the potential to establish ongoing research collaborations with interested attendees through cross-national use of the tool.

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