Deprescribing is tough in “time-poor” environments


Source: Michael B., Flickr

But it is an important advancement that requires our immediate attention, says this hospital pharmacist

Sophie Paviour from Redland-Wynnum Hospitals in Brisbane has asked fellow pharmacists to be more conscious of reviewing medications within the primary care setting.

In a letter to the Journal of Pharmacy Practice and Research, Paviour delves into how pharmacists can improve the quality use of medicines and medication safety.

In particular, she says medication reviews and deprescribing are important advancements that should be undertaken more often.

“As a hospital pharmacist I can appreciate the inherent difficulty in deprescribing in time-poor clinical environments,” she says.

“Unfortunately, in my experience, the medications associated with admission represent the most pressing concerns and often take precedence. The consideration of potentially inappropriate medications is lower down the list of priorities.”

However, she calls on pharmacists engaged in primary care to be conscious that medication reviews “could result in clinically meaningful outcomes for their patients”.

“Deprescribing is an important advancement in the practice of quality use of medicines and medication safety, which calls for immediate attention,” says Paviour.

Her comment is timely as recent research shows the prevalence of polypharmacy, particularly in aged care facilities, is high and increasing.

Researchers from Monash University and Alfred Hospital in Melbourne found pharmacist-led medication reviews in the primary care setting resulted in a significant reduction in the mean number of medications and drug-related problems.

“A complete medication list is a key initial step in the deprescribing process,” they said.

You may also be interested in:

Deprescribing: barriers and enablers

Polypharmacy can trigger decline and death: Monash study

Tackling the ‘prescribing cascade’ in seniors

Clinical Tips: Medication health for seniors

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3 Comments

  1. HMR ANYONE?
    08/09/2016

    “medication reviews and deprescribing should be undertaken more often”….CORRECT!
    “deprescribing is an important advancement in the QUM and medication safety”…CORRECT!
    polypharmacy is high and increasing……CORRECT!
    I have a grand solution…..cap all meaningful clinical pharmacist input in the community setting. Can I ask how often one should undertake medication reviews when such limitations have been put on the HMR program (20 patient cap at 2 year intervals)?
    Can I also point out deprescribing directly impacts the bottom line of community pharmacies through reduced sales and medication reviews should be conducted independently to avoid bias.

  2. MudgeeWinePharmacist
    08/09/2016

    Agreed! But the biggest hurdle to me is the lack of guidelines (if you know of any I would love you to link them). As a HMR pharmacist this is something I think of with very review but unless it is causes the patient a problem it is hard to state why it should be removed (considering there was a clinical reason for starting it in the first place – even if no one know why now!)

  3. Drugby
    13/09/2016

    Deprescribing resources
    There are some great deprescribing resources available. See http://www.cpsedu.com.au/posts/view/47/2016-Deprescribing-Resources

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