BMJ Medicine Pilot Shows ACMI Tool Embedded in NHS Records Flags Anticholinergic Burden for 65+ Patients

The ACMI assigns points to medications based on observed one-year delirium and fall rates in older adults, then integrates directly into GP and hospital EPR systems to list high-scoring patients alongside their contributing drugs. In the Bradford primary-care pilot, the tool generated ready-to-use lists for pharmacists; subsequent deployment at two acute trusts made the score recalculate automatically on any anticholinergic prescription or discontinuation. This workflow embedding distinguishes ACMI from earlier scales that required separate web calculators or manual summation.

Approximately half of UK adults over 65 receive at least one anticholinergic agent yearly, and cumulative burden is linked to delirium, falls and longer-term cognitive decline. The pilot demonstrated that automated flagging removes the main barrier to structured medication review, yet the study provides no randomised comparison of actual fall or delirium incidence before versus after implementation. Larger-scale outcome data are therefore still required.

Existing anticholinergic scales have shown modest observational associations but rarely reached routine care; ACMI’s EPR integration addresses that implementation gap. Remaining questions include calibration drift across different electronic systems, equity of access in non-pilot regions, and whether score-driven deprescribing produces sustained clinical benefit rather than surrogate improvements in prescribing counts.

Next steps include planned expansion to additional NHS trusts and linkage to routine hospital episode statistics to test whether flagged patients experience measurable reductions in fall-related admissions within 12 months.