Optimizing Deprescribing Practices for Overactive Bladder Treatment in Elderly Patients: A Mixed Methods Study in Primary Care

Background: Potentially inappropriate medication 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 exploring alternative options for treating OAB and deprescribing anticholinergic drugs commonly used in OAB. The research aims to evaluate deprescribing efficiency through a mixed methods approach, combining quantitative assessment and qualitative exploration of perceptions, experiences, and potential barriers among patients and healthcare personnel. Objectives: To evaluate the efficiency and safety of the intervention where healthcare staff in primary care encourage patients to participate in deprescribing drugs for OAB. Additionally, to identify factors contributing to or obstructing the deprescribing process, driving more informed decisions in deprescribing and supporting effective and safe patient treatment. Methods: The DROP study employs a Randomized Controlled Trial (RCT) with an embedded sequential explanatory mixed methods approach. General practices within the North Denmark region will be paired based on GP numbers and urban or rural locations and randomized into intervention and control groups. The intervention group will receive an deprescribing algorithm, promoting appropriate medication usage. Quantitative data will be collected from the RCT and Danish registries for prescription analysis. Qualitative data will be obtained through interviews and focus groups with GPs, staff members, and patients, merged for comprehensive understanding. Results: The DROP study is in progress, with general practice randomization ongoing. Practices are scheduled for inclusion from December 2023 to April 2024, with a 6-month patient follow-up period. Results will be analyzed using intention-to-treat for the RCT and thematic analysis for qualitative data. Quantitative outcomes will focus on prescription and symptom changes, while qualitative analysis will explore experiences and perceptions. Conclusions: The DROP study aims to provide evidence-based deprescribing interventions in primary care for OAB drugs with unfavorable risk-benefit profiles. It seeks to generate evidence for deprescribing practices, influencing healthcare best practices.