Anticholinergic Medication Management System: Patient-Centered Tools for Safer Deprescribing and Side Effect Monitoring
This innovation comprises two complementary patient-centered tools designed to address the growing need for anticholinergic medication management: the Pittsburgh Anticholinergic Symptoms Scale (PASS) Version 2, a validated self-report assessment tool that measures occurrence and severity of anticholinergic side effects, and a Shared Decision Making Infographic Tool that empowers patients to engage prescribers in deprescribing conversations. Together, these tools facilitate measurement-based care, improve patient-physician communication, and support quality improvement initiatives in anticholinergic medication optimization across diverse healthcare settings.
Description
The Pittsburgh Anticholinergic Symptoms Scale (PASS) Version 2 is a patient-friendly, self-report assessment tool that measures both peripheral and central anticholinergic side effects and their impact on quality of life. The scale was developed and refined through two quality improvement projects at Western Psychiatric Hospital-UPMC and takes 6-8 minutes to complete. Unlike anticholinergic medication burden scales that rely on drug potency ratings or laboratory assays, PASS is agnostic to daily dosage or medication potency, instead focusing directly on patient-reported symptoms. The tool includes visual aids such as cartoon faces to help patients accurately score their symptom burden and has demonstrated strong correlation between improvement in anticholinergic symptom scores and quality of life improvements when medications are tapered or discontinued. Clinical validation has shown the scale is particularly effective in identifying benefits for cognitively impaired patients during deprescribing interventions. The Shared Decision Making Infographic Tool complements PASS by providing patients with a clear, accessible framework to review their anticholinergic medications and engage prescribers in evidence-based conversations about medication necessity. Anticholinergic medications, while indicated for various conditions (Parkinson's disease, overactive bladder, motion sickness, etc.), are frequently continued indefinitely without reassessment, leading to cumulative anticholinergic burden from multiple medications. This infographic tool helps patients understand potential side effects and facilitates collaborative decision-making about whether tapering or discontinuing these medications is clinically appropriate, addressing both individual medication burden and cumulative anticholinergic effects from multiple sources.Applications
- Electronic Health Record Integration: Build PASS and infographic tools into EHR platforms for real-time symptom monitoring, enabling measurement-based clinical practice and automated reporting for quality improvement initiatives and pay-for-performance programs.- Healthcare System Quality Improvement Programs: Deploy in small, medium, and large healthcare systems for deprescribing initiatives targeting anticholinergic medication optimization, with potential for value-based care reimbursement and benchmark reporting.
- Insurance and Payor Platforms: License to health insurers for online prescriber support tools and member self-monitoring programs, supporting deprescribing initiatives and medication optimization strategies.
- Digital Health and Telemedicine Applications: Integrate into medication optimization and deprescribing software platforms serving clinics, healthcare systems, insurers, and direct-to-consumer markets.
- Pharmaceutical Clinical Trials: License to pharmaceutical companies developing non-anticholinergic alternatives for head-to-head comparison studies demonstrating competitive advantages in side effect profiles.
Advantages
- Immediate Clinical Feedback: Provides real-time assessment of anticholinergic side effects during clinic visits, enabling prescribers to quickly enact treatment plans and medication changes in busy clinical settings.- Validated Sensitivity to Change: Demonstrates consistent measurement of improvement when anticholinergic medications are tapered or stopped, with strong correlation between symptom reduction and quality of life enhancement.
- Patient Empowerment: Simple, patient-friendly tools require no complex calculations or technical expertise, enabling patients and caregivers to self-monitor symptoms and engage prescribers in shared decision-making conversations.
- Reduced Medication Burden: Facilitates appropriate deprescribing of medications no longer needed, decreasing pill burden while mitigating side effects including dry mouth, constipation, blurred vision, urinary retention, tachycardia, and memory impairment.
- Cognitive Protection: Particularly effective in identifying and tracking benefits for patients with baseline cognitive impairment, supporting population-level efforts to reduce anticholinergic exposure linked to dementia risk in aging populations.