title: Anticholinergic prescription: are healthcare professionals the real burden?
abstract: OBJECTIVE
  Anticholinergic medication is the medical treatment for overactive bladder (OAB). These drugs can act on the central nervous system and can lead to cognitive decline, dementia, and potentially death. Patients taking drugs with anticholinergic effects increase their anticholinergic burden-defined as the cumulative effect of taking one or more drugs that can have adverse effects. When prescribing anticholinergic medication for the elderly, we must choose the right drug. We aimed to discover the level of understanding on this subject and its application to real clinical practice amongst our healthcare professionals (HCPs).
  
  
  METHODS
  An 18-point questionnaire was distributed to urogynaecologists, general gynaecologists, urologists, geriatricians, general practitioners (GPs), and nurse specialists to assess knowledge on the subject.
  
  
  RESULTS
  A total of 96 HCPs completed the questionnaire. The nurse specialists had the highest score in identifying that oxybutynin was the drug most likely to cross the blood-brain barrier (BBB). The urogynaecologists had the highest score in identifying that trospium chloride was least likely to cross the BBB, whereas the GPs had the lowest score. Solifenacin was the most popular anticholinergic drug prescribed in the elderly without dementia. Trospium chloride was the most popular drug prescribed in the elderly with dementia.
  
  
  CONCLUSIONS
  We have found that knowledge is lacking amongst all our HCPs, but especially amongst our first-line doctors, our GPs. Education is key in developing knowledge and safe prescribing, to improve the care we give to our patients.
authors.affiliation: Department of Urogynaecology, King's College Hospital, London, UK. george.araklitis@nhs.net.
authors.forename: George
authors.identifier: http://orcid.org/0000-0002-3817-2962
authors.initials: G
authors.lastname: Araklitis
authors.affiliation: Department of Urogynaecology, King's College Hospital, London, UK.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Thiagamoorthy
authors.affiliation: Department of Urogynaecology, King's College Hospital, London, UK.
authors.forename: Jo
authors.initials: J
authors.lastname: Hunter
authors.affiliation: Department of Urogynaecology, King's College Hospital, London, UK.
authors.forename: Angie
authors.initials: A
authors.lastname: Rantell
authors.affiliation: Department of Urogynaecology, King's College Hospital, London, UK.
authors.forename: Dudley
authors.initials: D
authors.lastname: Robinson
authors.affiliation: Department of Urogynaecology, King's College Hospital, London, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Cardozo
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001812:Blood-Brain Barrier / Q000187:drug effects; D018680:Cholinergic Antagonists / Q000009:adverse effects* / Q000493:pharmacokinetics; D060825:Cognitive Dysfunction / Q000139:chemically induced / Q000523:psychology*; D000075203:Contraindications, Drug; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D058005:General Practitioners / Q000523:psychology; D000072219:Geriatricians / Q000523:psychology; D006176:Gynecology; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013041:Specialties, Nursing; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000523:psychology; D000072178:Urologists / Q000523:psychology
chemical_list: D018680:Cholinergic Antagonists
keywords: Anticholinergic burden; Anticholinergic load; Anticholinergic medication; Dementia; Overactive bladder