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

Carrie Stewart* (Corresponding Author), Katie Gallacher, Athagran Nakham, Moira Cruickshank, Rumana Newlands, Christine Bond, Phyo Kyaw Myint, Debi Bhattacharya, Frances S. Mair

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)
3 Downloads (Pure)


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 (PROSPERO CRD42018109084) 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 1,764 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.
Original languageEnglish
Pages (from-to)1451-1460
Number of pages10
JournalInternational Journal of Clinical Pharmacy
Early online date25 Jun 2021
Publication statusPublished - Dec 2021

Bibliographical note

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. The funding sponsors had no role in the design, execution, interpretation or writing of the study.

Open access via Springer agreement.

Data Availability Statement

The online version contains supplementary material available at


  • Anticholinergics
  • deprescribing
  • systematic review
  • qualitative research
  • intervention implementation


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