by Alka Bhalla, PharmD, MPH candidate ‘18
What is deprescribing?
Deprescribing has been described as a process where better health outcomes in patients can be achieved through optimizing medications. This includes
- reducing number of inappropriate medications and/or
- reducing a dose of medication that is needed.
What is the process of deprescribing?
- Ensure the medication list is accurate (includes prescription, OTCs, vitamins, herbals).
- Critically review the medication list.
- Assess adherence to medications.
- Cross-reference medications with indications
- Identify issues related to medications
- Prepare, in partnership, with the patient, a deprescribing regimen.
Medical indications change over time to emulate the changing function and health of the patient. Frequently review the medication list and support the patient towards optimizing their health outcomes.
There is little to no evidence to show health care practitioners how to stop medications.
Medstoppers.com is a resource that can help you start the conversation of deprescribing with your patients.
Medstoppers.com is an interactive expert opinion database, for the frail elderly, which provides guidance as to how to stop a medication and what to watch for, specifically, signs and symptoms, when stopping a medication.
We know that the frail elderly tend to take more medications and experience more medication-related adverse outcomes than their peers. Therefore, when conducting a medication review, use a deprescribing lens in the frail elderly questioning for example, prolonged use or need of medications (e.g., bisphosphonates, statins) and whether there is net benefit in continuing symptomatic treatment (e.g., anticholinergics).
Case: You are a pharmacist in Perth and Mrs. Fitzgerald is seeing you for a medication review. Her family doctor has asked for your recommendations. Mrs. Fitzgerald has had 3 falls in the last 3 months along with a recent UTI. This prompted consideration of a medication review. Mrs. Fitzgerald is a 78 year old frail elderly widow who lives alone in her house in Perth. She has 2 children who currently live in Toronto.
Temazepam 30 mg once daily for sleep x 10 years
Alendronate 70 mg once weekly for osteoporosis x 10 years
Donepezil 10 mg once daily for mild cognitive impairment × 2 years.
Acetylsalicylic acid 81 mg once daily to reduce MI risk × many years.
Other medical conditions: Diabetes (A1c 7.1% Jan 15, 2016, hypertension (BP in clinic 138/80 on February 10, 2016.
Note there is information unknown to us when we review her chart.
Let’s take the case above. A change in health status has prompted a medication review.
Enter the above medications into medstopper.com.
Here is the result, a medstopper plan: (click to view PDF)
From work in Health Literacy we know that actively involving patients in the clinical decision-making processes, taking into account their values and main concerns, will promote trust and confidence in making informed decisions about their health.
Use clear communication and non-medical terminology in the clinical communication exchanges.
To support effective communication and understanding of the deprescribing plan, using the teach back technique and creating an environment where patients feel safe to ask questions, can help patient’s understanding of their medical conditions and enable adherence to medical instructions.
As health care providers, we have a role to improve our patients’ health literacy by “communicating the right information, to the right people, in the right way, at the right time” (Hoffman-Goetz et al, 2014).
- Frank C and Weir E. Deprescribing for older patients (review). CMAJ 2014:186(18); 1369-76.
- Frank C. Deprescribing: a new word to guide medication review (commentary). CMAJ 2014:186(6);407-8.
- Podcast: https://therapeuticseducation.org/podcast/episode-296-medstopper-%E2%80%93-deprescribing-resource-healthcare-professionals
- Hoffman-Goetz L, Donelle L, Ahmed R. Health literacy in Canada. A primer for students. 2014. Canadian Scholars’ Press Inc., Toronto, ON.