Queen's University Belfast

Academic Institute

Bernadette McGuinness

HSC Research and Development Division Doctoral Fellowship Award

Yes

E086

Background - Anticholinergic (ACh) medication is frequently used to treat women with overactive bladder (OAB) symptoms. This is a bladder problem that means you have an urgent need to pass water that cannot be deferred and can result in a leak of urine. These drugs can have adverse effects and as we age the potential to experience these effects can increase. ACh medication is frequently used to treat overactive bladder symptoms in women as well as alternative surgical treatments such as intravesical onabotulinum toxin injections, sacroneuromodulation or percutaneous tibial nerve stimulation. There is some evidence that other non-OAB medication can have anticholinergic side effects and have been associated with a greater risk of memory issues and mortality. Methods – The study will have four objectives: (1) Explore how commonly these medications are used and prescribing patterns across Northern Ireland. (2) Link healthcare data already collected within the NHS to examine the use of these medications in adult women in Northern Ireland (NI) and explore whether being on these medications is potentially linked to risk of vascular disease, dementia, or death. This will be done by identifying all women in NI over the age of 18 years who have been on these medications over a twelve-year period from 2010-2022 using the Enhanced Prescribing Database, a centralised record of all medications dispensed in community pharmacies across NI. This will be linked to information from emergency departments, hospital admission and discharge datasets and death data to quantify the risk of vascular disease, dementia diagnosis or death. (3) We will explore the value of four different scales that have been developed to look at anticholinergic effects. (4) And finally assess whether any identified risks may be reversible by comparing those who stop medication during the study period with those with continued use.

It is hoped this research will help inform national policy on management of urinary incontinence, particularly the pathway for overactive bladder patients. If OAB anticholinergic medications are found to increase mortality and morbidity, then this research will help inform clinicians’ discussion with service users directly on the use of these medications particularly in those with other co-existing risk factors. It may help to change current NICE guidance with earlier recourse to alternative interventions for management of OAB such as alterative pharmacotherapy with a beta-3-agonist, intravesical onabotulinum toxin, sacral neuromodulation and posterior tibial nerve stimulation. With over 600,000 prescriptions dispensed in Northern Ireland in 2020 for genito-urinary disorders, this research could have a significant impact on avoiding prescription of potentially inappropriate or harmful medication and could deliver a significant reduction in hospital admissions and prescribing costs. The research outcomes will be used for the co-design and co-production of a patient decision aid, presenting any potential health risks in a more accessible format, will provide service users with a resource to make more informed decisions about management of their OAB symptoms when considering these medications as part of shared decision making with their clinician. This will be complemented with a similar resource targeted for clinicians to aid this discussion around mortality and morbidity associated with OAB medication and to include risks of anticholinergic burden framed around their background risk based on population age and gender related mortality. This will provide a useful tool for clinicians in both primary and secondary care to ensure women are fully informed before commencing any OAB anticholinergic medication.

06/11/2023

TRE