Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

Arbour SeniorCare

Name of Innovative Program: 
Monitoring Cholinesterase Inhibitors
Sponsoring Organization
Arbour SeniorCare
Name of Innovative Program Lead: 
Michael C. LaFerney
E-mail Address of Innovative Program Lead:
Project Description: 
To require monitoring of cholinesterase inhibitor effectiveness in long-term care setting as these medications are not effective in an estimated 80 % of patients yet they remain on them for life at a high cost to the health care system and a wide range of side effects to patients.I know of no other medication that is prescribed to so many people with a known noneffectiveness.Go: provides a protocol /model to monitor these and eliminate unneeded meds.
Creativity and Innovation: 
This simple protocol provide a model to monitor whether these meds are effective.Since it is not being done this represents a simple but effective way to save alot of money for the health care industry. Innovative and creative in that it will be going up against the very strong pharmecutical industry marking machine which can only show a small statistical significance but no real clinical advantage to taking these drugs.
I've taken the lead by calling attention to this in various nursing forums in publication and clinical settings. I have advocated for this group of patients (Alzheimers and dementia) who cannot often advocate fro themselves. I propose a model to have patients who are helped by these patients stay on them and those who are not don't.The current plan is put them on these meds until they die and don;t monitor effectiveness. 0 % of patietns on these meds develop anorexia, Syncope is a much mor common side effect than drug company literatiure says.. I'm fighting for these people.
It will be sustainable as long as these medications are big business. We are attmepting to eliminate other classes of medications harmful to patients with dementias as antipsychotics which have a black box warning.We should do the same for these cholinesterase inhibitors which are costly and innefective.
All nursing homes can adapt this simple model using a one page test. Simple to deliver and use. The MMSE (mini mental state exam)Can be done by nurses or others trained in it's use. Working with the prescribers those patients who are helped can stay on it and the patients who aren't will come off-avoiding side effects and saving thousands of dollars.
Will help the 10-20 % of those patients in which they are effective and can be discontinues in the 80% or so who get no benefit, suffer side effects, and save money for your healthcare system. Will prevent side effects as syncope and anorexia that create more problems and cost for the patient.Although described in some of the literature as “mild,” or not serious, several reactions can be quite severe and are often attributed to other causes. Many times, side effects triggered by cholinesterase inhibitors are treated with other drugs. This initiative has saved money and prevented further deterioration to those with cognitive deficits.