Living in a society where medications are commonplace, it's crucial to understand that while prescriptions can be life-saving and beneficial when used correctly, there comes a point when they might do more harm than good. Today, we're diving deep into the world of "Deprescribing" – the process of reducing or stopping medications that no longer serve the patient.
Deprescribing: What's It All About?
In 2003, the term 'deprescribing' made its debut in the medical literature. Fast forward two decades, and most healthcare professionals are well aware of the concept. However, putting it into practice can be quite the challenge. As humorously described in an NHS workshop, "Deprescribing is like teenage sex... Everybody talks about it, no one knows how to do it, and everybody thinks everybody else is doing it!"
Goals of Deprescribing: Rethinking Medications
Medications are typically started with good intentions, aiming to provide benefits and serve a purpose. The problem arises when these medications aren't continually re-evaluated. Deprescribing's primary goal is to assess the risk versus the benefit of each drug, ultimately aiming to reduce or eliminate medications that no longer align with the person's health goals, serve a purpose, or might even be causing harm.
Dealing with "Polypharmacy": Too Many Pills?
Polypharmacy, the use of five or more prescriptions, is on the rise, particularly among an aging population. In Canada, over two-thirds of individuals above 65 take at least five medications, and one in ten seniors take at least fifteen. As the number of medications increases, unfortunately so does the risk of harmful effects, falls, and hospitalizations. Shockingly, almost 1% of all Canadian seniors are hospitalized each year due to adverse drug events, costing an estimated $35.7 million. Additionally, nearly two million Canadian seniors take at least one risky medication, leading to increased hospitalizations and a substantial financial burden on the system.
Deprescribing's Transformative Power
Research shows that deprescribing has the potential to improve outcomes for patients and the healthcare system. It can:
- Eliminate ineffective treatments
- Reduce the risk of interactions
- Decrease potential for side effects
- Improve quality of life
- Decrease pill burden
- Enhance adherence to necessary medications
- Reduce healthcare costs
- Address prescribing cascades (drugs being used to treat the side effects of another drug)
- Increase safety (particularly for nearby pets, children, and loved ones) by reducing medications with potential for misuse or dependency
- Bring down risk of hospitalizations, falls, and mortality (death!)
The Need for Regular Reassessment
Change is constant, and people's health conditions, symptoms, and goals evolve over time. Medications must be regularly re-evaluated to ensure they are continuing to benefit the person taking them.
Why Isn't Deprescribing More Common?
Deprescribing isn't as simple as it sounds. It requires time and effort from healthcare professionals to review medications in the context of the patient's current health status, values, and goals. A shortage of healthcare professionals and a strapped healthcare system can make this challenging. Other factors, such as the "if it ain't broke, don't fix it" mentality, concerns about symptoms returning, unclear prescribing information, and readiness for change, can also impede deprescribing efforts.
Is Deprescribing for You?
If you are wondering, is this for me (or a loved one), reflect on the following questions:
Are you feeling confused or overwhelmed by the medications you take? Do you wish you could take less pills?
Are you "stuck" on a medication that is no longer right for you?
Have you tried to stop your medication (on your own, or with a doctor) and keep coming up against rebound or withdrawal symptoms?
Are you worried about risks from your meds?
Have you experienced falls?
Do you take multiple medications and experience other unexplained symptoms like dry mouth, fatigue, or memory problems?
If you answered yes to any of the above, a focused medication review with a deprescribing specialist is worth exploring.
Types of Medications for Deprescribing
Several classes of medications often require deprescribing due to the potential for risks outweighing benefits. Examples include proton pump inhibitors (PPIs), benzodiazepines, antihyperglycemic agents, antidepressants, opioids, and drugs with anticholinergic effects. It's essential to undergo a personalized assessment to determine the best approach for you. What is appropriate to stop for one person, may not be for another. It’s important for your regimen to be individualized to your unique needs. Many drugs need to be tapered down safely and should not be stopped abruptly. Never stop or change a medication without first speaking with a health provider.
Take the First Step Towards Deprescribing
A patient-centered approach involving shared decision-making with your healthcare provider is crucial. Open communication about your values, beliefs, and health goals will guide the deprescribing process. It is helpful to work with a pharmacist specializing in deprescribing to safely reduce or stop medications where possible.
Your Simple Health: Your Deprescribing Solution
At Your Simple Health, we're dedicated to helping you navigate the deprescribing journey. If you believe deprescribing could benefit you or a loved one, reach out to us for a complimentary discovery call.
Disclaimer
Please note that the information provided is for educational purposes only and should not be considered personal medical advice. Always consult your healthcare provider before making any changes to your medications.
References:
Alberta Health Services. Deprescribing Resource Guide. November 2021.
Bruyere Research Institute. www.Deprescribing.org.
Canadian Medication Appropriateness and Deprescribing Network. What is Deprescribing. Accessed online from https://www.deprescribingnetwork.ca/useful-resources/
Endsley S. Deprescribing Unnecessary Medications: A Four-Part Process. Fam Pract Manag. 2018 May/Jun;25(3):28-32. PMID: 29989773.
NHS Value of York, Clinical Commissioning Group. Deprescribing workshop. Accessible at file:///C:/Users/16472/Dropbox/PC/Desktop/workshop-3-deprescribing-presentation-final-v1.pdf
NSW Therapeutic Advisory Group. Deprescribing tools. https://www.nswtag.org.au/deprescribing-tools/