“The best doctor gives the least medicines,” according to the scientist, Benjamin Franklin. In the 1700s, a patient only had one doctor and few medications available. Today, 67% of patients over the age of 60 consume five or more medications, including over-the-counter drugs and supplements. More doctors have implemented a new methodology to treating older Americans known as deprescribing, due to the rise of drug consumption, possible negative interactions, and increased risk of side effects.
A new website maintained by the Canadian Deprescribing Network provides information for both U.S. and Canadian doctors to determine if a patient’s medication should be stopped, switched or reduced. The website developers are a group of health professionals, policymakers, and patient advocates. Some of the more common medications listed include ones for heartburn, diabetes, and reflux.
“What was good for you once might not be as good for you now,” says Cara Tannenbaum from the Institute of Gender and Health in Montreal. As patients age, medication may become less effective or processed differently in the body causing complications with long-term drugs. Statins, commonly prescribed for cholesterol control, can cause weakness in muscles and lead to the risk of falling in patients over the age of 75.
Tannenbaum encourages patients to speak up, “On a regular basis, patients should be asking their health-care providers, “Is this still the right medication for me, and if not, what other drugs or nondrug therapies are safer and equally effective?”
Patient education is another effective strategy for deprescribing, according to a study led by Tannenbaum, published in JAMA Internal Medication in 2014. The study shows educating senior citizens about the risk of sedative overuse led to a 27% discontinuation of the drug after a consultation with a doctor or pharmacist.
Holly Holmes, chair of the Division of Geriatric and Palliative Medicine at McGovern Medical School at The University of Texas Health Science Center, describes how a short-term medication prescription given in a hospital can lead to a patient “staying on them forever.” Holmes uses the example of proton pump inhibitors used to treat short-term heartburn or reflux problems is one drug that patients want to continue after discharge.
To that end, provider education is also oftentimes just as important. In most cases, there is a lack of insight and transparency across a patient’s healthcare continuum. An overarching, agnostic evaluation of a populations medication use showcases the ability to illuminate the blind spots associated with multiple providers involved in a patient’s care.
“Getting patients off of the wrong medications decreases healthcare costs, adverse drug events, drug interactions, medication non-adherence, and improves the overall health of a patient,” stated PharmMD’s Director of Clinical Operations, Stacey Grant. “With 23 percent of polypharmacy patients at risk for major drug interaction, medication risk management is more important than ever before.”
Although a growing percentage of patients are in a situation of polypharmacy and uncoordinated care from their doctors, more providers are heeding the wise words of Benjamin Franklin to deprescribe for better health. The end result is a population that is on the right medication, at the right time – providing transparent and quantifiable healthcare outcomes for the improvement of population health as a whole.
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