Category: Professional Posters
Purpose: Elderly patients are more susceptible to the anticholinergic side effects of medications as a result of physiological changes with aging. In Singapore, many drugs with anticholinergic effects (DACEs) are classified as Pharmacy-only Medicines for the treatment of minor ailments. The sale of these DACEs is primarily based on pharmacists’ discretion. It is a concern that inappropriate long-term use of DACEs by the elderly may bring about more harm than good. This study aimed to assess the knowledge of community pharmacists in ensuring the appropriate use of medications in geriatrics. It also sought to examine the effectiveness of a pharmacists’ training.
Methods: In this IRB-approved exploratory survey study, questionnaires were administered to pharmacists from a community chain before and after the training to assess their knowledge of DACEs, anticholinergic side effects, as well as the dispensing habits of pharmacists. Pharmacists were not allowed to refer to any references when attempting the questionnaire. The training comprised a 30-minute presentation on immediate and long-term anticholinergic effects, the list of Pharmacy-only medicines with anticholinergic effects available in the community chain and alternative medications suitable for geriatric use. Chi-square test was employed to compare the number of pharmacists who provided the correct responses before and after the training.
Results: A total of 30 pharmacists participated in the survey, of which 9 pharmacists (30%) had at least 5 years of practice. Analysis of baseline knowledge showed that while each first-generation anti-histamine available in the community pharmacy chain (promethazine, diphenhydramine, dimenhydrinate, chlorpheniramine or promethazine) was correctly identified as a DACE by at least 28 pharmacists (93.3%), only up to 18 pharmacists (60%) were aware of the anticholinergic activity of antispasmodics (such as hyoscine or dicyclomine). Constipation, dry eye, urinary retention and dry mouth were correctly identified as anticholinergic side effects by at least 28 pharmacists (93.3%), while only 5 pharmacists (16.7%) recognized dementia as a long-term complication of DACE use. Checking for patients’ medical conditions and drug allergies were practiced by at least 28 pharmacists (93.3%), while checking for patients’ age during dispensing was performed by only 11 pharmacists (36.7%). Half of the pharmacists would attempt to offer safer alternative medications when encountering elderly patients buying DACEs for themselves. After the training, 24 pharmacists (80%) correctly identified central nervous system (CNS) anticholinergic effects. Results of the Chi-square test revealed that the increase in the number of pharmacists providing the correct responses after the training was statistically significant (p<0.05).
Conclusion: This study demonstrated gaps in community pharmacists’ knowledge of anticholinergic effects and DACEs. While the training was effective in enhancing pharmacists’ knowledge in the short-term, there may be a need for continuing training to ensure proper use of medications in the growing geriatric population.