As the population ages, older Canadians are living with multiple chronic conditions and research shows that they are taking many medications.
About a quarter of Canadians over 65 take ten or more prescription drugs, according to a report by the Canadian Institute of Health Information. Some medications can become unnecessary – or even harmful – over time, with age and sometimes because of drug interactions. This can lead to unnecessary hospitalizations and health system costs. One study estimated that Canadians spend $1.4 billion each year in health care costs to treat harmful effects from medications, including fainting, falls, fractures and hospitalizations.
Patients don’t want to be overmedicated either. Another study found that Canadian seniors are prepared to reduce their medications or stop them entirely if their doctors advise it is safe.
Ontario research hospitals are helping physicians and health care professionals change prescribing practices to help patients take only the medications they need, reducing the medication burden in Ontario while improving the quality of life for seniors.
Dr. Paula Rochon at Women’s College Hospital identifies the problem of prescribing cascades
This issue was first described in 1995 by Dr. Paula Rochon, now the Vice President of Research at Women’s College Hospital, and co-author Dr. Jerry Gurwitz. Since then, there has been increasing focus on smarter prescribing practices and Drs. Rochon and Gurwitz recently revisited their two-decades-old article to see how far we’ve come.
“Since we first described prescribing cascades, they have made an important impact on medication safety in Canada and abroad,” Dr. Rochon says. “I am greatly encouraged by the work happening today across CAHO hospitals and by organizations including the Canadian Deprescribing Network.”
Dr. Barb Farrell at Bruyère Research Institute is developing guidelines to help doctors deprescribe
Dr. Barb Farrell is a lead researcher with the Bruyère Research Institute and a founding member of the Canadian Deprescribing Network. Together with her research team, she is developing evidence-based guidelines to help guide Canadian healthcare practitioners on when and how to deprescribe medications to improve patient care. The goal is to help clinicians evaluate, reduce and stop medications that may no longer benefit a patient or may cause them harm.
“Our hope is that these guidelines will provide the framework necessary for clinicians around the world to make the best decisions possible for their patients,” said Farrell.
The Evidence-Based Deprescribing Guideline Symposium, hosted by the Bruyère Deprescribing Research team, brought together 130 participants from ten countries to share best practices and develop tools.
Dr. Michelle Greiver at North York General Hospital is using data to improve prescribing patterns
Dr. Michelle Greiver is a practicing Family Physician and Research Scientist at North York General Hospital (NYGH). She is working to decrease the number of drugs prescribed to seniors and optimize care for patients with complex needs through a new research project called SPIDER (Structured Process Informed by Data, Evidence and Research).
SPIDER leverages electronic medical record data to identify seniors taking multiple medications and improves prescribing patterns by bringing together a broad range of health care players, each with a specific role. Hospital health planners and quality improvement coaches work closely with family physicians and patient advisors to implement practice changes and improve care for complex seniors taking multiple medications. Meanwhile, researchers use the electronic medical record data to measure overall changes in the types and number of drugs prescribed. The researchers also interview patients and physicians to find out what worked and what didn’t. This is all being done while preserving the privacy and confidentiality of patient information.
“Reducing medications that are not benefiting seniors could help reduce side effects like dizziness and confusion,” says Dr. Greiver. “This could lead to a decrease in falls and an improvement in patients’ ability to manage at home. Consequently, this could impact some areas of NYGH such as the emergency department (fewer visits due to falls and fractures) and the geriatric inpatient unit (fewer admissions).”
Led by Dr. Greiver, a team of more than 50 investigators will roll out SPIDER in five provinces across Canada.
North York General Hospital, Bruyere Continuing Care and Women’s College Hospital are three of Ontario’s 23 research hospitals that contribute to a healthier, wealthier, smarter province. Look for other RESEARCH SPOTLIGHT posts on our Healthier, Wealthier, Smarter blog or join the conversation about why health research matters for Ontario on Twitter, using the hashtag #onHWS.
Feature photo: Simone van der Koelen on Unsplash