Understanding Stakeholder Views Regarding the Design of an Intervention Trial to Reduce Anticholinergic Burden: A Qualitative Study

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 h...

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Autores principales:	Yvonne Cunningham, Karen Wood, Carrie Stewart, Athagran Nakham, Rumana Newlands, Katie I. Gallacher, Terence J. Quinn, Graham Ellis, Richard Lowrie, Phyo Kyaw Myint, Christine Bond, Frances S. Mair
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	anticholinergics deprescribing polypharmacy interviews focus groups qualitative research Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/fa700eae9e4b4bd195b077fd5748fea4
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spelling	oai:doaj.org-article:fa700eae9e4b4bd195b077fd5748fea42021-11-12T05:44:56ZUnderstanding Stakeholder Views Regarding the Design of an Intervention Trial to Reduce Anticholinergic Burden: A Qualitative Study1663-981210.3389/fphar.2021.608208https://doaj.org/article/fa700eae9e4b4bd195b077fd5748fea42021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fphar.2021.608208/fullhttps://doaj.org/toc/1663-9812Background: 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.Yvonne CunninghamKaren WoodCarrie StewartAthagran NakhamRumana NewlandsKatie I. GallacherTerence J. QuinnGraham EllisRichard LowriePhyo Kyaw MyintChristine BondFrances S. MairFrontiers Media S.A.articleanticholinergicsdeprescribingpolypharmacyinterviewsfocus groupsqualitative researchTherapeutics. PharmacologyRM1-950ENFrontiers in Pharmacology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	anticholinergics deprescribing polypharmacy interviews focus groups qualitative research Therapeutics. Pharmacology RM1-950
spellingShingle	anticholinergics deprescribing polypharmacy interviews focus groups qualitative research Therapeutics. Pharmacology RM1-950 Yvonne Cunningham Karen Wood Carrie Stewart Athagran Nakham Rumana Newlands Katie I. Gallacher Terence J. Quinn Graham Ellis Richard Lowrie Phyo Kyaw Myint Christine Bond Frances S. Mair Understanding Stakeholder Views Regarding the Design of an Intervention Trial to Reduce Anticholinergic Burden: A Qualitative Study
description	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.
format	article
author	Yvonne Cunningham Karen Wood Carrie Stewart Athagran Nakham Rumana Newlands Katie I. Gallacher Terence J. Quinn Graham Ellis Richard Lowrie Phyo Kyaw Myint Christine Bond Frances S. Mair
author_facet	Yvonne Cunningham Karen Wood Carrie Stewart Athagran Nakham Rumana Newlands Katie I. Gallacher Terence J. Quinn Graham Ellis Richard Lowrie Phyo Kyaw Myint Christine Bond Frances S. Mair
author_sort	Yvonne Cunningham
title	Understanding Stakeholder Views Regarding the Design of an Intervention Trial to Reduce Anticholinergic Burden: A Qualitative Study
title_short	Understanding Stakeholder Views Regarding the Design of an Intervention Trial to Reduce Anticholinergic Burden: A Qualitative Study
title_full	Understanding Stakeholder Views Regarding the Design of an Intervention Trial to Reduce Anticholinergic Burden: A Qualitative Study
title_fullStr	Understanding Stakeholder Views Regarding the Design of an Intervention Trial to Reduce Anticholinergic Burden: A Qualitative Study
title_full_unstemmed	Understanding Stakeholder Views Regarding the Design of an Intervention Trial to Reduce Anticholinergic Burden: A Qualitative Study
title_sort	understanding stakeholder views regarding the design of an intervention trial to reduce anticholinergic burden: a qualitative study
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/fa700eae9e4b4bd195b077fd5748fea4
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Understanding Stakeholder Views Regarding the Design of an Intervention Trial to Reduce Anticholinergic Burden: A Qualitative Study

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