title: Anticholinergic Drug Burden in Persons with Dementia Taking a Cholinesterase Inhibitor: The Effect of Multiple Physicians.
abstract: OBJECTIVE
  To explore the association between the number of physicians providing care and anticholinergic drug burden in older persons newly initiated on cholinesterase inhibitor therapy for the management of dementia.
  
  
  METHODS
  Population-based cross-sectional study.
  
  
  METHODS
  Community and long-term care, Ontario, Canada.
  
  
  METHODS
  Community-dwelling (n = 79,067, mean age 81.0, 60.8% female) and long-term care residing (n = 12,113, mean age 84.3, 67.2% female) older adults (≥66) newly dispensed cholinesterase inhibitor drug therapy.
  
  
  METHODS
  Anticholinergic drug burden in the prior year measured using the Anticholinergic Risk Scale.
  
  
  RESULTS
  Community-dwelling participants had seen an average of eight different physicians in the prior year. The odds of high anticholinergic drug burden (Anticholinergic Risk Scale score ≥ 2) were 24% higher for every five additional physicians providing care to individuals in the prior year (adjusted odds ratio = 1.24, 95% confidence interval = 1.21-1.26). Female sex, low-income status, previous hospitalization, and higher comorbidity score were also associated with high anticholinergic drug burden. Long-term care facility residents had seen an average of 10 different physicians in the prior year. After a sensitivity analysis, the association between high anticholinergic burden and number of physicians was no longer statistically significant in the long-term care group.
  
  
  CONCLUSIONS
  In older adults newly started on cholinesterase inhibitor drug therapy, greater number of physicians providing care was associated with higher anticholinergic drug burden scores. Given the potential risks of anticholinergic drug use, improved communication among physicians and an anticholinergic medication review before prescribing a new drug are important strategies to improve prescribing quality.
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.|Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Christina E
authors.initials: CE
authors.lastname: Reppas-Rindlisbacher
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Hadas D
authors.initials: HD
authors.lastname: Fischer
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Kinwah
authors.initials: K
authors.lastname: Fung
authors.affiliation: Institute for Clinical Evaluative Sciences Queen's, Kingston, Ontario, Canada.|Department of Medicine, Queen's University, Kingston, Ontario, Canada.
authors.forename: Sudeep S
authors.initials: SS
authors.lastname: Gill
authors.affiliation: Institute for Clinical Evaluative Sciences Queen's, Kingston, Ontario, Canada.|Division of Geriatric Psychiatry, Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.
authors.forename: Dallas
authors.initials: D
authors.lastname: Seitz
authors.affiliation: Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.|Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Cara
authors.initials: C
authors.lastname: Tannenbaum
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Paula A
authors.initials: PA
authors.lastname: Rochon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003142:Communication; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000379:methods / Q000706:statistics & numerical data*; D003704:Dementia / Q000188:drug therapy*; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000009:adverse effects / Q000706:statistics & numerical data*; D008134:Long-Term Care; D008297:Male; D009864:Ontario; D010820:Physicians / Q000706:statistics & numerical data*
chemical_list: D018680:Cholinergic Antagonists; D002800:Cholinesterase Inhibitors
keywords: anticholinergic; cholinesterase inhibitors; dementia; older adults; physicians