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

Stewart, C., Gallacher, K. , Nakham, A., Cruickshank, M., Newlands, R., Bond, C., Myint, P. K., Bhattacharya, D. and Mair, F. S. (2021) Barriers and facilitators to reducing anticholinergic burden: a qualitative systematic review. International Journal of Clinical Pharmacy, 43(6), pp. 1451-1460. (doi: 10.1007/s11096-021-01293-4) (PMID:34173123)

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.

• Item Type: Articles
• Additional Information: This study is funded by The Dunhill Medical Trust (RPGF1806/66) as part of a series of work building an evidence synthesis suite to inform a future randomised trial of reducing anticholinergic related harm in older adults.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Gallacher, Dr Katie and Mair, Professor Frances

Creator Roles

Gallacher, K.: Conceptualization, Funding acquisition, Investigation, Methodology, Resources, Writing – review and editing
Mair, F.: Conceptualization, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Writing – review and editing

• Authors: Stewart, C., Gallacher, K., Nakham, A., Cruickshank, M., Newlands, R., Bond, C., Myint, P. K., Bhattacharya, D., and Mair, F. S.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
• Journal Name: International Journal of Clinical Pharmacy
• Publisher: Springer
• ISSN: 2210-7711
• ISSN (Online): 2210-7703
• Published Online: 25 June 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in International Journal of Clinical Pharmacy 43(6): 1451-1460
• Publisher Policy: Reproduced under a Creative Commons License