Understanding stakeholder views regarding the design of an intervention trial to reduce anticholinergic burden: a qualitative study

Cunningham, Y. et al. (2021) Understanding stakeholder views regarding the design of an intervention trial to reduce anticholinergic burden: a qualitative study. Frontiers in Pharmacology, 12, 608208. (doi: 10.3389/fphar.2021.608208) (PMID:34867311) (PMCID:PMC8633300)

Abstract

Background: Anticholinergic burden (ACB), is defined as the cumulative effect of anticholinergic medication which are widely prescribed to older adults despite increasing ACB being associated with adverse effects such as: falls, dementia and increased mortality. This research explores the views of health care professionals (HCPs) and patients on a planned trial to reduce ACB by stopping or switching anticholinergic medications. The objectives were to explore the views of key stakeholders (patients, the public, and HCPs) regarding the potential acceptability, design and conduct of an ACB reduction trial. Materials and Methods: We conducted qualitative interviews and focus groups with 25 HCPs involved in prescribing medication with anticholinergic properties and with 22 members of the public and patients who were prescribed with the medication. Topic guides for the interviews and focus groups explored aspects of feasibility including: 1) views of a trial of de-prescribing/medication switching; 2) how to best communicate information about such a trial; 3) views on who would be best placed and preferred to undertake such medication changes, e.g., pharmacists or General Practitioners (GPs)? 4) perceived barriers and facilitators to trial participation and the smooth conduct of such a trial; 5) HCP views on the future implementability of this approach to reducing ACB and 6) patients’ willingness to be contacted for participation in a future trial. Qualitative data analysis was underpinned by Normalization Process Theory. Results: The public, patients and HCPs were supportive of an ACB reduction trial. There was consensus among the different groups that key points to consider with such a trial included: 1) ensuring patient engagement throughout to enable concerns/potential pitfalls to be addressed from the beginning; 2) ensuring clear communication to minimise potential misconceptions about the reasons for ACB reduction; and 3) provision of access to a point of contact for patients throughout the life of a trial to address concerns; The HCPs in particular suggested two more key points: 4) minimise the workload implications of any trial; and 5) pharmacists may be best placed to carry out ACB reviews, though overall responsibility for patient medication should remain with GPs. Conclusion: Patients, the public and HCPs are supportive of trials to reduce ACB. Good communication and patient engagement during design and delivery of a trial are essential as well as safety netting and minimising workload.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cunningham, Dr Yvonne and Gallacher, Dr Katie and Mair, Professor Frances and Ellis, Dr Graham and Lowrie, Dr Richard and Wood, Miss Karen
• Authors: Cunningham, Y., Wood, K., Stewart, C., Nakham, A., Newlands, R., Gallacher, K. I., Quinn, T. J., Ellis, G., Lowrie, R., Myint, P. K., Bond, C., and Mair, F. S.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
• Journal Name: Frontiers in Pharmacology
• Publisher: Frontiers Media
• ISSN: 1663-9812
• ISSN (Online): 1663-9812
• Copyright Holders: Copyright © 2021 Cunningham, Wood, Stewart, Nakham, Newlands, Gallacher, Quinn, Ellis, Lowrie, Myint, Bond and Mair
• First Published: First published in Frontiers in Pharmacology 12: 608208
• Publisher Policy: Reproduced under a Creative Commons License

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
304360		Understanding stakeholder views regarding the design of a trial intervention to reduce anticholinergic burden	Frances Mair	Office of the Chief Scientific Adviser (CSO)	CGA/18/47	HW - General Practice and Primary Care