Effect of Potentially Inappropriate Use of Antimuscarinic Medications on Healthcare Use and Cost in Individuals with Overactive Bladder

Suehs, Brandon T.; Davis, Cralen; Franks, Billy; Yuran, Thomas; Ng, Daniel; Bradt, Jason; Knispel, John; Vassilakis, Maria Espejo; Berner, Todd

doi:10.1111/jgs.14030

Cited by 24 publications

(17 citation statements)

References 42 publications

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“…Anticholinergic burden arising from an accumulation of medicines with anticholinergic properties is associated with an increased risk of cardiovascular disease, mortality and use of healthcare services (Myint et al 2015, Campbell et al 2016. In one US study, one third of anticholinergic prescriptions were found to be potentially inappropriate, and this was associated with increased hospitalisation (Suehs et al 2016). Caution is recommended regarding the prescription of anticholinergics for incontinence in older people and they should be avoided in those with dementia (O'Mahony et al 2015).…”

Section: Anticholinergicsmentioning

confidence: 99%

“…In 2017, almost £148 million was spent on seven million prescriptions for anticholinergics in England (NHS Digital 2018), and consequently these are relatively expensive medicines (Samuelsson et al 2015, Moyson et al 2017. Because of their potential for significant harm, high cost and limited efficacy, the identification of approaches to discontinue anticholinergics is recommended (Suehs et al 2016). One randomised controlled trial of patients receiving anticholinergics for more than six months found that these could be successfully discontinued in 35% of patients (Lee et al 2011).…”

Section: Anticholinergicsmentioning

confidence: 99%

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Role of nurses in supporting proactive deprescribing

Wright¹,

Scott²,

Buck³

et al. 2019

Nursing Standard

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Deprescribing is the term used to describe the discontinuation of medicines. It can be either 'reactive', for example in response to an adverse event or therapeutic failure, or 'proactive', when the prescriber and patient decide to discontinue the medicine because its future benefits no longer outweigh its potential for harm. At present, there is a limited amount of proactive deprescribing activity in primary and secondary care. This article provides the rationale for increasing proactive deprescribing activity, lists the medicines this relates to, identifies the barriers and enablers to its implementation, and describes the potential role of the nurse in this process.

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Section: Anticholinergicsmentioning

confidence: 99%

Section: Anticholinergicsmentioning

confidence: 99%

Role of nurses in supporting proactive deprescribing

Wright¹,

Scott²,

Buck³

et al. 2019

Nursing Standard

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show abstract

“…Beers, Screening Tool of Older Persons Prescriptions) and judgement‐based measures such as the Medication Appropriateness Index which asks a series of questions about the appropriateness of the drug in question. These drugs are considered inappropriate because older adults who use PIMs are more likely to experience adverse drug reactions, falls, hospitalization and increased healthcare costs …”

Section: Introductionmentioning

confidence: 99%

Factors associated with potentially inappropriate medication use in community-dwelling older adults in the United States: a systematic review†

Nothelle

Sharma

Oakes

et al. 2019

International Journal of Pharmacy Practice

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Objectives Potentially inappropriate medication (PIM) use in older adults is a prevalent problem associated with poor health outcomes. Understanding drivers of PIM use is essential for targeting interventions. This study systematically reviews the literature about the patient, clinician and environmental/system factors associated with PIM use in community‐dwelling older adults in the United States. Methods PRISMA guidelines were followed when completing this review. PubMed and EMBASE were queried from January 2006 to September 2017. Our search was limited to English‐language studies conducted in the United States that assessed factors associated with PIM use in adults ≥65 years who were community‐dwelling. Two independent reviewers screened titles and abstracts. Reviewers abstracted data sequentially and assessed risk of bias independently. Key findings Twenty‐two studies were included. Nineteen examined patient factors associated with PIM use. The most common statistically significant factors associated with PIM use were taking more medications, female sex, and higher outpatient and emergency department utilization. Only three studies examined clinician factors, and few were statistically significant. Fifteen studies examined system‐level factors such as geographic region and health insurance. The most common statistically significant association was the south and west geographic region relative to the northeast United States. Conclusions Amongst older adults, women and persons on more medications are at higher risk of PIM use. There is evidence that increased healthcare use is also associated with PIM use. Future studies are needed exploring clinician factors, such as specialty, and their association with PIM prescribing.

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“…One study found that anticholinergic prevalence among older adults with dementia was 23% [30]. Another found that 31% of Medicare Advantage Prescription Drug Plan members who were newly initiated on a bladder antimuscarinic had a drug-drug or drug-disease interaction; dementia was the most common such interaction, present in 11% of people initiated on a bladder antimuscarinic drug [17]. Previous research has shown that multiple anticholinergic drugs are often prescribed concurrently, causing anticholinergic side effects to accumulate [31,32], and that bladder antimuscarinic use is common in individuals receiving ChEIs for treatment of dementia.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the concern about anticholinergic side effects, bladder antimuscarinics may be involved in adverse drug-drug interactions [17]. For example, because bladder antimuscarinics work by blocking the activity of acetylcholine at muscarinic receptors, they may directly counteract the already-modest therapeutic effect of cholinesterase inhibitors (ChEIs), one of two US Food and Drug Administration (FDA)-approved pharmacotherapies for dementia [18].…”

Section: Introductionmentioning

confidence: 99%

Patterns of Potentially Inappropriate Bladder Antimuscarinic Use in People with Dementia: A Retrospective Cohort Study

Green

Segal

Boyd

et al. 2020

Drugs - Real World Outcomes

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Background Emergency department (ED) visits or hospitalizations should prompt review of the patient's medications after discharge and targeted deprescribing to reduce ongoing risks. Objective To see if this is happening, we sought to examine the proportion of serious falls and delirium that were followed by a prescription fill for a bladder antimuscarinic. Our secondary objective was to identify concurrent use of other anticholinergics, cholinesterase inhibitors (ChEIs), and diuretics among people with dementia taking bladder antimuscarinics. Methods Retrospective descriptive study using data from the National Health and Aging Trends Study (2011-2014) linked with Medicare claims from 2010-2014. The primary outcome was the proportion of serious falls or delirium that were followed by a bladder antimuscarinic prescription fill within 12 months. The secondary outcome was the proportion of individuals concurrently receiving prescriptions for bladder antimuscarinics, other strong anticholinergics, ChEIs, and diuretics. Results During the observation period, 8.88% of people with dementia filled a bladder antimuscarinic prescription. Over one-third (35%) initiated use after being identified as having dementia. Many used bladder antimuscarinics concurrently with other strong anticholinergics (19%), diuretics (42%), and ChEIs (32%). The majority (76%) of serious falls or delirium among people with dementia and bladder antimuscarinic use were followed by a bladder antimuscarinic prescription within 12 months. Conclusions In this descriptive study, bladder antimuscarinic prescriptions were often filled irrespective of dementia status, serious falls, or delirium. Concurrent use of other anticholinergics, diuretics, and ChEIs was common. Falls and delirium should trigger review of the medication list after discharge and targeted deprescribing in people with dementia.

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Effect of Potentially Inappropriate Use of Antimuscarinic Medications on Healthcare Use and Cost in Individuals with Overactive Bladder

Cited by 24 publications

References 42 publications

Role of nurses in supporting proactive deprescribing

Role of nurses in supporting proactive deprescribing

Factors associated with potentially inappropriate medication use in community-dwelling older adults in the United States: a systematic review†

Patterns of Potentially Inappropriate Bladder Antimuscarinic Use in People with Dementia: A Retrospective Cohort Study

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