CAHO hospitals are driving safer prescribing practices for Ontarians

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

Dr. Paula RochonA prescribing cascade occurs when a doctor misinterprets a patient’s adverse drug reaction as a new medical condition and responds by prescribing another medication.

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 FarrellDr. 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.

Evidence-Based Deprescribing Guideline Symposium at Bruyere Hospital

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 GreiverDr. 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

 

Research Spotlight: North York General Hospital

Research Chairs Poised to Ask the Right Questions 

As a leading community academic hospital, North York General Hospital (NYGH) is uniquely positioned to transform and enhance patient care through continuous evolution. In 2011, the hospital released Strategy 2015-2018, which envisioned the achievement of excellence in integrated patient-centred care through learning, innovation and partnership. To achieve this stratagem, research and innovation plays a central role assuring the necessary evolution contributing to quality, efficiency and excellence in patient-centred care. The creation of the first-ever research chairs was a key part of building on the academic foundation.

“We know the majority of hospital care in Canada is provided in community hospitals, so the scholarly work we do will make a difference well beyond our catchment areas,” says Dr. Donna McRitchie, Vice President, Medical & Academic Affairs. “Our strategy for research and innovation is built around our research chairs, who will explore new ways to improve processes for delivering care.”

To date, North York General has recruited four research chairs, beginning with the recruitment of the Gordon F. Cheesbrough Research Chair in Family and Community Medicine, named after one of North York General’s greatest leaders and champions, and the first of its kind in Canada. The Chair’s purpose is to drive interdisciplinary, interprofessional and crossinstitutional research investigations, with the goal of enhancing the quality and outcomes of care provided at the individual and system level. Until recently the position was held by Dr. Frank Sullivan. NYGH is currently recruiting for the role.

Dr. Monika Kastner NYGK

Monika Kastner joined NYGH in February 2016 as the Research Chair in Knowledge Translation and Implementation. Knowledge translation is regarded as a bridge between the creation and implementation of knowledge and as such, it is highly relevant to NYGH strategic objectives.

“There is so much important work in health care research that is underutilized simply because we do not have adequate processes and channels for implementation and dissemination,” Monika says. “I’m interested in bridging that gap to help enhance the uptake of services and products for patients and families.”

North York General Hospital (NYGH) recently welcomed Patricia Trbovich

Patricia Trbovich joined the hospital in August 2016 as the Badeau Family Research Chair in Patient Safety and Quality Improvement. In her role, she focuses on reducing preventable medical errors and creating innovative solutions in a community academic hospital setting to enhance patient safety and quality of care.

“We have to proactively identify risks and mitigate them before they cause harm, as opposed to solely reacting once adverse events have already occurred,” Patricia says. “We have to embrace complexity and figure out where it’s needed and where we can reduce it.”

As the newest member recruited in August 2017, Katie Dainty, PhD, is the hospital’s Research Chair in Patient-Centred Outcomes. Katie is interested in finding new ways to enhance this experience by applying an often-ignored lens: the patient’s perspective.

NYGH Katie Dainty

“It’s important to remember that even if the care was clinically perfect, a patient’s life may be changed dramatically and they have to deal with after effects, both physically and psychologically,” Katie says. “The question is: what can we do leading up to, during and after hospital care to ensure there is the best possible long-term outcome for the patient and their family?”

The appointment of hospital research chairs is part of NYGH’s overall strategy to transform care through applied research and innovation. The hospital is immensely grateful to the North York General Foundation for their support in establishing these Research Chairs.

North York General Hospital is one of Ontario’s 23 research hospitals that contribute to a healthier, wealthier, smarter province. Read more Research Spotlight posts and other patient and researcher stories on our Healthier, Wealthier, Smarter blog or join the conversation about why health research matters for Ontario on Twitter, using the hashtag #onHWS.

 

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