Speaker
Emily G. McDonald MDCM, MSc, FRCPC
Scientific Director; Canadian Deprescribing Network
Associate Professor of Medicine; McGill University
Keywords
MedSafer, Deprescribing
Key Points
- Overmedicating seniors is a worldwide problem. Seniors are prescribed an average of 7 different drug classes, and 25 percent of older people are prescribed 10 or more drug classes. More drugs are prescribed to people in rural regions, low-income neighborhoods or residing in long-term care.
- Polypharmacy can result in adverse drug events. There are more adults seeking medical treatment due to adverse drug events, resulting in more hospitalization, unnecessary hospital costs, and early death. A person’s risk of increased adverse drug event increases by 10 percent for each drug.
- One solution is deprescribing, looking at an accurate list of medications, looking at the indication of each medication and thinking through the present and future risks/benefits, and developing a program to taper or change medications, minimizing side effects and maximizing benefits.
- MedSafer was built to identify deprescribing opportunities, facilitate Rx checkup, cross-reference medical conditions, lab values, life expectancy, and frailty with the medication list, and integrate for use with the electronic health record.
- In 2015, the MedSafer Pilot was conducted as a controlled trial in older adults in 3 sites/4 hospitals in Quebec and Ontario. The pilot found MedSafer had a large impact on deprescribing, especially for antipsychotics.
- In 2015-2016 a larger, randomized trial was launched to see what effect MedSafer has on adverse drug events. For this trial 11 hospitals were divided into 3 clusters, representing different regions of Canada. Close to 6,000 patients were enrolled. Reports that were provided to medical providers were found to increase deprescribing across the board. There was no significant difference in adverse drug events within 30 days of discharge.
Discussion Themes
– To scale up these types of interventions, we need government and patient support to integrate into existing interfaces for long-term care.
– Future studies might follow patients for a longer period of time, have more pharmacy involvement in adjudication, and include more clusters.
Read more about MedSafer.
Tags
#pctGR, @Collaboratory1