Karalyn Huxhagen outlines a plethora of resources and thought-provoking materials to help pharmacists interested in deprescribing
Whether you are standing in a community pharmacy, performing a HMR, working in a clinic or GP practice or visiting an aged care facility one of the most common questions that patients will ask is ‘can you give me less medications.’. Patients want to take fewer medicines due to many reasons.
A few issues raised by patients are:
- Cost of medicines
- Burden of ability to swallow a large amount of medication
- Increased risk of interaction and adverse effects when taking multiple medications
- Being able to remember to take their medication
- Being able to comply with variable and complex dosing times and methods of delivery
- Burden of visiting their doctor and pharmacy for repeats medication that fall due on a variety of days per month.
There is a plethora of resources and tools available to assist pharmacists understand the process of the deprescribing pathway.
Deprescribing – well worth a follow as they post links to latest research papers, podcasts and resources in this area.
Deprescribing Net – Canadian Deprescribing Network
Pharmeducation – Debbie Rigby and Dr Geraldine Moses regularly post material related to deprescribing.
Academy for Geriatric Medicine
Journal of the American Geriatric Society (JAGS) – a must follow site. JAGS highlights emerging insights on older adults, geriatric syndromes, geriatric psychiatry and geriatric diseases and disorders. One of their latest tweets is a reference to an online journal article titled ‘What is known about preventing, detecting, or reversing prescribing cascades: A scoping Review.’
Another article on the JAGS twitter site “Tools for Deprescribing in Frail Older Persons and those with a limited life expectancy: A systematic Review’ published on 13th October 2018 has this useful diagram to give you guidance of where to start and how to progress with the deprescribing decision making.
Primary Health Tasmania Deprescribing guidelines. www.primaryhealthtas.com.au
- Deprescribing quick reference guide
- A guide to deprescribing allopurinol
- A guide to deprescribing antihypertensive agents
- A guide to deprescribing antiplatelet agents
- A guide to deprescribing antipsychotics
- A guide to deprescribing benzodiazepines
- A guide to deprescribing bisphosphonates
- A guide to deprescribing cholinesterase inhibitors
- A guide to deprescribing glaucoma eye drops
- A guide to deprescribing NSAIDs
- A guide to deprescribing opioids
- A guide to deprescribing proton pump inhibitors
- A guide to deprescribing statins
- A guide to deprescribing sulfonylureas
- A guide to deprescribing vitamin D and calcium
Deprescribing.org (https://deprescribing.org )
This website has many guidelines and algorithms to assist the pharmacist and Prescriber to plan the deprescribing cascade for the patient. There are also resources for patients to help them manage the deprescribing pathway.
Purple Pen – ‘Deprescribing with Amy Page. ‘
While this podcast specifically addresses deprescribing many of the other presentations discuss the relative worth of medication in treating patients with multiple morbidities. For example the cardiology based podcasts discuss rationalisation of interventions; Dr Rohan Elliott addresses principles of geriatric medicines.
If you put ‘deprescribing’ in the search engine of your favourite podcast app you will find many other podcasters who speak about this topic. I tend to use Purple Pen and Australian Prescriber podcasts as they have an Australian focus but Deprescribing is an international issue and there is a plethora of research, guidelines and algorithms to guide implementation in your chosen area of pharmacy practice.
While there are an abundance of journal articles available on this subject I would recommend following the work of Kristen Anderson and Dr Christopher Freeman from the University of Queensland. There are several publications including:
- ‘ Negotiating “Unmeasurable Harm and Benefit”: Perspectives of General Practitioners and Consultant Pharmacists on Deprescribing in the Primary Care Setting’ Anderson, Kristen, Foster, Michelle, Freeman, Christopher; Leutsch, Karen; Scott, Ian
- ‘Evidence-based deprescribing: reversing the tide of potentially inappropriate polypharmacy’. Journal of Clinical Outcomes Management 23 (8) 359-369. Scott,Ian; Anderson, Kristen and Freeman, Christopher
- ‘First do no harm: a real need to deprescribe in older patients’ Ian A Scott, Kristen Anderson, Christopher R Freeman and Danielle A Stowasser.Med J Aust 2014; 201 (7): 390-392. || doi: 10.5694/mja14.00146
Applying the deprescribing process in practice
I particularly like the Primary Health Tasmania Quick Reference Guide titled ‘A Guide to Deprescribing’ as this format is easy to follow and can be used in the discussion with the prescriber and the patient.
The ultimate role of the process is to monitor the progress and review the plan at regular intervals. With all deprescribing or tapering plans it is important to monitor and intervene if issues arise. Pharmacists in all areas of practice have a role in deprescribing and the journey is improved if there is communication and collaboration between pharmacists. It is important that the patient is supported by a health care team that has communicated what the deprescribing plan is and what the end goal is.
Deprescribing is an area that pharmacists can contribute to extensively and we need to make sure we are able to be work with the patient and their health care team to support the patient.
Karalyn Huxhagen is a community pharmacist and was 2010 Pharmaceutical Society of Australia Pharmacist of the Year. She has been named winner of the 2015 PSA Award for Quality Use of Medicines in Pain Management and is group facilitator of the Mackay Pain Support Group.