Barriers and facilitators to reducing anticholinergic burden: a qualitative systematic review

Carrie Stewart; Katie Gallacher; Athagran Nakham; Moira Cruickshank; Rumana Newlands; Christine Bond; Phyo Kyaw Myint; Debi Bhattacharya; Frances S Mair

doi:10.1007/s11096-021-01293-4

Barriers and facilitators to reducing anticholinergic burden: a qualitative systematic review

Int J Clin Pharm. 2021 Dec;43(6):1451-1460. doi: 10.1007/s11096-021-01293-4. Epub 2021 Jun 25.

Authors

Carrie Stewart¹, Katie Gallacher², Athagran Nakham³, Moira Cruickshank⁴, Rumana Newlands⁴, Christine Bond⁵, Phyo Kyaw Myint³, Debi Bhattacharya⁶, Frances S Mair²

Affiliations

¹ Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, University of Aberdeen, 1:128, Polwarth Building, Foresterhill Health Campus, Aberdeen, AB25 2ZD, UK. carrie.stewart@abdn.ac.uk.
² General Practice and Primary Care, University of Glasgow, Glasgow, UK.
³ Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, University of Aberdeen, 1:128, Polwarth Building, Foresterhill Health Campus, Aberdeen, AB25 2ZD, UK.
⁴ Health Services Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
⁵ Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
⁶ School of Pharmacy, University of East Anglia, Norwich, UK.

Abstract

Background Despite common use, anticholinergic medications have been associated with serious health risks. Interventions to reduce their use are being developed and there is a need to understand their implementation into clinical care. Aim of review This systematic review aims to identify and analyse qualitative research studies exploring the barriers and facilitators to reducing anticholinergic burden. Methods Medline (OVID), EMBASE (OVID), CINAHL (EMBSCO) and PsycINFO (OVID) were searched using comprehensive search terms. Peer reviewed studies published in English presenting qualitative research in relation to the barriers and facilitators of deprescribing anticholinergic medications, involving patients, carers or health professionals were eligible. Normalization Process Theory was used to explore and explain the data. Results Of 1764 identified studies, two were eligible and both involved healthcare professionals (23 general practitioners, 13 specialist clinicians and 12 pharmacists). No studies were identified that involved patients or carers. Barriers to collaborative working often resulted in poor motivation to reduce anticholinergic use. Low confidence, system resources and organisation of care also hindered anticholinergic burden reduction. Good communication and relationships with patients, carers and other healthcare professionals were reported as important for successful anticholinergic burden reduction. Having a named person for prescribing decisions, and clear role boundaries, were also important facilitators. Conclusions This review identified important barriers and facilitators to anticholinergic burden reduction from healthcare provider perspectives which can inform implementation of such deprescribing interventions. Studies exploring patient and carer perspectives are presently absent but are required to ensure person-centeredness and feasibility of future interventions.

Keywords: Anticholinergics; Deprescribing; Intervention implementation; Qualitative research; Systematic review.

Publication types

Review
Systematic Review

MeSH terms

Caregivers
Cholinergic Antagonists* / adverse effects
Health Personnel*
Humans
Pharmacists
Qualitative Research

Substances

Cholinergic Antagonists

Abstract

Publication types

MeSH terms

Substances

Grants and funding