Deprescribing – a way to reduce inappropriate use of drugs for overactive bladder in primary care (DROP): protocol for a cluster-randomized controlled trial with an embedded explanatory sequential mixed-method study. (Preprint)

Abstract

Potentially inappropriate medication (PIM) remains a significant concern in general practices, particularly in the context of overactive bladder (OAB) treatment for individuals aged 65 and older. This study focuses on the exploration of alternative options for treating OAB and the deprescribing of anticholinergic drugs commonly used in OAB. The research aims to comprehensively evaluate the efficiency of deprescribing through a mixed methods approach, combining quantitative assessment and qualitative exploration of perceptions, experiences, and potential barriers among patients and healthcare personnel.

to evaluate the efficiency and safety of the intervention in which healthcare staff in primary care encourage patients to participate in deprescribing their drugs for OAB In addition, we aim to identify factors contributing to or obstructing the deprescribing process that will drive more informed decisions in the field of deprescribing and support effective and safe treatment of patients.

The DROP study employs a rigorous research design, utilizing a Randomized Controlled Trial (RCT) with an embedded sequential explanatory mixed methods approach. All general practices within the North Denmark Region will be paired based on the number of General Practitioners (GPs) and urban or rural locations. The matched pairs will be randomized into intervention and control groups. The intervention group will receive an algorithm designed to guide the deprescribing of drugs for OAB, promoting appropriate medication usage. Quantitative data will be collected from the RCT, including data from Danish registries for prescription analysis. Qualitative data will be obtained through interviews and focus groups with GPs, staff members, and patients. Finally, the quantitative and qualitative findings are merged to gain a comprehensive understanding of deprescribing for OAB. This integrated approach enhances insights and supports future improvement of the intervention.

The DROP study is currently in progress, with randomization of general practices underway. While they have not been invited to participate yet, they will be. The inclusion of GP practices is scheduled to take place from December 2023 to April 2024. The follow-up period for each patient is 6 months. Results will be analysed through an intention-to-treat analysis for the RCT and a thematic analysis for the qualitative component. Quantitative outcomes will focus on changes in prescriptions and symptoms, while the qualitative analysis will explore experiences and perceptions.

The DROP study aims to provide an evidence-based intervention in primary care that ensures the deprescription of drugs for OAB when there is an unfavorable risk-benefit profile. The DROP study's contribution lies in generating evidence for deprescribing practices and influencing best practices in healthcare.

The North Denmark Region (K2023-012) ClinicalTrials.gov identifier: NCT06110975