Web-based app supporting safer prescribing in older people
Medichec is a free web-based app designed to review patients’ medications and minimise the risks from anticholinergic drugs. These drugs are commonly prescribed for older people with chronic conditions including depression, anxiety, pain, allergies, incontinence, and sleep problems. Developed by researchers at South London and Maudsley NHS Foundation Trust, the app helps clinicians and nurses to quickly and simply identify potentially harmful drugs so they can be discontinued or switched to safer alternatives.
The use of drugs with anticholinergic effects are known to increase risk of cognitive impairment, dementia (particular Alzheimer’s disease), and early death in older people. They work by blocking acetylcholine, a nervous system neurotransmitter, and have a cumulative effect on cognition.
With Medichec, over 2000 drugs can be searched and categorised according to their safety. The online tool rates drugs using a novel Anticholinergic Effect on Cognition (AEC) scale, developed from a systematic review of existing evidence about each drug. This evidence-based scale takes into account whether a drug is able to reach the brain and its relative effect on cognition.
The app provides individual drugs with an ACE score—a score of 2 or above indicates a drug should be withdrawn or switched. A total AEC score, combining all the individual drugs a patient is taking, of 3 or above calls for a medication review.
Details of the tool and its development have been published in the International Journal of Geriatric Psychiatry. Currently, information is being gathered on other harmful neuropharmacological mechanisms that may be included in future updated versions of the Medichec app.
Working with technology partners Mindwave Ventures, there are plans to develop Android and iPhone versions of Medichec. This will enable many more clinicians, across a wide range of healthcare settings, to have access to the AEC scale at their fingertips. This will give both patients and clinicians a full picture of how each of these drugs is likely to affect their cognition, as well as their overall health. Medichec is dedicated to increasing awareness about the risks of anticholinergic drugs.