We enabled medication reviews of patients with long-term prescriptions for urinary incontinence medication which enabled clinicians to recommend ‘drug holidays’.

Background
The long-term prescribing of anticholinergic drugs, used to treat urinary incontinence, has been associated with an increased risk of cognitive impairment, dementia and mortality.

Clinicians have been advised to consider offering patients ‘drug holidays’ for short periods to assess whether there has been any natural remission of the condition, whether the drugs are still effective and whether there is a continued need for treatment.

Action
Working with Greater Preston and Chorley and South Ribble Clinical Commissioning Groups (CCGs), our Medicines Optimisation team created a review tool and templates for the EMIS system to enable a safe and consistent medication review process.

The team worked collaboratively with GP practices to identify patients for whom a four-week ‘drug holiday’ was appropriate.

Patients received an initial telephone consultation offering advice and guidance, followed by a further consultation four weeks later to assess outcomes.

Impact

Across Greater Preston and Chorley and South Ribble CCGs:

• urinary incontinence medication reviews were carried out across 32 GP practices
• 238 patients were identified as being suitable and agreeable to taking a ‘drug holiday’
• after four weeks, 144 patients (61%) did not restart drug treatment and their medication was discontinued
• the total anticholinergic burden score was reduced by 432 points* across the patient cohort
• an estimated annual NHS saving of £29,451 was recorded.

*assigning an ACB score of 3 on ACB calculator for each drug stopped.

“I have been taking this drug since 1999 and now I feel much fitter without it.”

“My dry mouth, headache and acid reflux have really improved since I stopped taking the bladder drug. So much so that I threw the oxybutynin tablets on the fire last week!”

“Stopping this medication has made no difference to my urinary symptoms.”

“I have been catheterised for nearly twenty years and wondered why I had to keep on taking this drug – big improvement in my life without it.”

Patient feedback