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Deprescribing lessons from Canada

Between 25-45% of elderly Americans are on five or more prescription medications, and more than 20% are taking at least 10 drugs. In the past 20 years, the rate of polypharmacy, or taking multiple drugs, has nearly doubled in the US. While drugs can improve and lengthen patients’ lives, the hazards of adverse events – including falls, hospitalization, and death – increases with every additional prescription.

To help combat this problem, the Lown Institute is conducting research and convening a working group of experts to create a framing paper and an action plan, as a first step towards a national strategy for addressing polypharmacy. 

As we look for potential deprescribing initiatives we can implement in America, we’re learning from experts in other countries like Canada and Australia, who are a step ahead in implementing programs and policies to curb the harmful effects of polypharmacy.

 

We recently attended a summit meeting of the Canadian Deprescribing Network (CaDeN), a group of health care leaders, clinicians, decision-makers, academic researchers and patient advocates working together to mobilize knowledge and promote the deprescribing of medication that may no longer be of benefit or that may be causing harm. Here are some highlights of what we learned from the summit:

  • For a sustainable solution, everyone has to be at the table. Even though physicians are usually in charge of prescribing medications, we need more than just physicians to discuss solutions to polypharmacy. Without buy-in from patient groups, pharmacists, and policymakers, it’s much harder to deprescribe. Impressively, the CaDeN summit brought together clinicians, policymakers, and representatives from seniors groups from every province in the network.  
  • Although Canada has universal health care, they still deal with many of the same issues we do in America. Physicians talked about how silos between specialties facilitate multiple prescriptions, without looking at the whole patient. And in both countries, alternative treatments to pain management and insomnia often are not covered by insurance, making them less accessible.
  • Seniors want to be involved in the deprescribing effort. Representatives from seniors organizations said that their constituents were very motivated to talk about polypharmacy, because almost all had stories from family or friends who suffered adverse events from inappropriate prescribing. They also brought great insight to the behavioral mechanisms behind deprescribing – for example, one advocate said that patients who are on a medication for decades can develop an emotional relationship to the medication, so acknowledging that barrier and providing an alternative therapy is essential.
  • Deprescribing will take both policy and culture change. Physicians find it very difficult to deprescribe medications on their own, because other physicians and patients are used to medication being the answer for all health problems. Clinicians said that they not only need government policies that facilitate deprescribing, but a change in mindset within the health care community that comes from within, not above.

To learn more about the Canadian Deprescribing Network, see their website and annual report

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