Key result
Higher prescribed medication count linked to ~57% greater odds of high anticholinergic burden in outpatients.
Why the study?
Anticholinergic burden is linked to serious adverse effects, but evidence regarding the extent of use of medicines with anticholinergic activity in Ethiopian outpatient settings is scarce.
In a resource-limited outpatient setting, nearly 10% of adult patients experience high anticholinergic burden, which is significantly driven by polypharmacy rather than age.
Polypharmacy was associated with higher odds of high anticholinergic burden in outpatients; hypothesis-generating for deprescribing trials in resource-limited settings.
Existing evidence links anticholinergic burden (ACB), the cumulative effect of medicines with anticholinergic activity, with serious adverse effects. There is scarcity of evidence on the extent of use of such medicines in Ethiopian outpatient settings. To assess the prevalence and determinants of high ACB (score ≥ 3) among adult patients, a cross-sectional study was conducted among adult patients (≥ 18 years) attending ambulatory clinic of University of Gondar Comprehensive Specialized Hospital (UoGCSH) between April and September 2022. ACB was calculated based on the medications patients were currently taking, identified from medical records and patient interviews. Descriptive statistics were used to summarize socio-demographic and clinical characteristics of participants. Logistic regression analysis was used to identify factors associated with high ACB (ACB score ≥ 3). 409 patients, median age 50 years (IQR 37-62, range 18-85), participated in this study. About a third (32%) of participants were exposed to at least one medication with anticholinergic activity. Approximately one-tenth (9.5%) of them were exposed to high ACB. Logistic regression analysis indicated that the increase in the number of medications was associated with a 1.57-fold (AOR 1.57; 95% CI 1.22-2.02) increase in the odds of high ACB. Medicines with anticholinergic activity are commonly prescribed to outpatients at UoGSCH, despite relatively younger demographics. When prescribing multiple medicines with anticholinergic properties, physicians need to be cautious as high ACB is cumulative.
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Gebreyohannes et al. (2025) studied this question. A total of 9.5% of outpatients had high anticholinergic burden (ACB score ≥ 3), with a 1.57-fold increase in odds associated with a higher number of prescribed medications.
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