The culture that drives medication overload

By Judith Garber | April 26, 2019

In the recent report, Medication Overload: America’s Other Drug Problem, The Lown Institute highlights the growing harm from taking too many medications, especially for older adults. More than 40 percent of all older adults take at least five prescription drugs, a 300 percent increase from 25 years ago. Every year, Americans over age 65 have preventable “adverse drug events” (ADEs) that lead to 280,000 hospital stays and nearly 5 million outpatient visits.

In a new op-ed on The Health Care Blog, clinical nurse, author, and Medication Overload working group member Theresa Brown, RN, explains one of the biggest drivers of medication overload and, from a health care provider’s perspective, why it is so hard to tackle:

“We are all, patients and prescribers, deeply embedded in a culture of prescribing, wedded to the idea that all health problems can be solved by taking a pill, or a lot of pills. Clinicians also feel increasingly pressured to hurry through appointments, and offering pills makes visits go faster. For patients, receiving a prescription often gives them a sense of being well-cared for.”

This culture can be extremely hard to change, even for clinicians who recognize the harm of too many medications, because many clinicians face barriers such as lack of time with patients, fear about harm from stopping prescriptions, lack of information about patients’ prescriptions, and the pressure to do “everything they can” for patients.

How can we create an environment that encourages conservative prescribing, rather than a “pill for every ill”? Brown writes that we need clinicians and patients to work together. “Patients need to understand that every drug has side effects, and dangerous drug-to-drug interactions are always possible [and] prescribers need more training to help them recognize medication overload,” Brown writes. Brown also notes that we need system changes as well to promote careful prescribing and deprescribing, such as reimbursing clinicians for conversations with patients about medications, including nurses and pharmacists on the care team, and coordination to make patients’ medication information available to all people on the care team.

For more about the culture of prescribing, read Theresa’s op-ed on The Health Care Blog!

To eliminate medication overload, serious cultural, educational, and policy changes are needed. This action plan offers recommendations for policymakers, health care institutions, clinicians, and patients across five key categories to reduce harm from multiple medication use. Suggested Citation: Eliminating medication overload: A national action plan. Working Group on Medication Overload. Brookline, MA: The Lown Institute, 2020. DOI: https://doi.org/10.46241/LI.YLBW4885

Pharmaceutical marketing is a significant factor in the growing public health crisis of medication overload, which puts millions of older adults at risk of preventable harm and premature death. This issue brief provides recommendations to reduce pharmaceutical industry influence by limiting pharma sales rep visits to clinicians and direct-to-consumer advertising.

This issue brief provides recommendations for clinical practice guidelines and electronic health records that would give clinicians the information they need to appropriately prescribe and deprescribe.