The appropriate use of medication is an important preventive and curative strategy in healthy aging. However, the risks associated with inappropriate medication use in the elderly are especially high and many are not receiving maximal benefit from the use of drug therapy.
Some statistics support the contention that as many as 50 per cent of all medication used by seniors is being used inappropriately and almost 25 per cent of hospital admissions of patients over 50 years of age result from medication problems.
The Team for Individualizing Pharmacotherapy in Primary Care for Seniors (TIPPS) Program is a multi-disciplinary research team whose focus is on finding better solutions to the problems seniors face when choosing or using medications.
TIPPS’ lead investigator Lisa Dolovich says, “On average in Ontario, if you are over 65, you filled as many as 27 claims for prescriptions last year. In our research we’ve found that those over 65 are taking at least eight different medications. And certainly in Canada drug costs are the fastest rising component of health-care spending.”
Taking multiple medications can lead to other complications, including issues around side-effects and drug interaction – what health-care professionals call the medication cascade.
TIPPS, a five-year research program funded by the Canadian Institutes of Health Research (CIHR) Institute of Aging, was formed by a group of researchers who recognized the need to improve medication use by seniors in primary care.
The program is exploring areas such as improving the use of therapeutic information, enhancing shared decision-making, reducing inappropriate prescribing, increasing the use of underutilized medications, determining the effect of multiple medications on an individual’s benefit or risk profile and improving compliance.
Dr. Dolovich says the interdisciplinary nature of the TIPPS team is integral to its success. “The program is unique in that it brings together researchers from different backgrounds – family medicine, pharmacy, clinical pharmacology, geriatrics, internal medicine, sociology, nursing, and epidemiology. The different disciplines share their diverse approaches, theoretical frameworks and knowledge with each other. Viewing the relevant issues from many angles results in more complete solutions to medication problems. We want to know how we can use medications better in the real world.”
TIPPS’ research projects centre on developing individualized solutions for patients, providers, and the health-care system.
Underway since 2002, the program has supported over 50 research projects such as the Transition to Insulin project; a qualitative study of the experience of patients with type 2 diabetes and large scale interventions such as The Community Hypertension Assessment Trial (CHAT) investigating the effect of community pharmacy based blood pressure monitoring sessions and COMPETE – Canada’s original electronic medical record research network specializing in the rigorous development, implementation and evaluation of electronic technologies in healthcare. Many of the projects are described on the TIPPS website www.tippsnetwork.ca.
“TIPPS coordinates; it connects all these projects so that the learnings from one project can be better transferred to other projects,” says Dr. Dolovich. “We want to identify interventions that help physicians, pharmacists and patients manage their medications better. But as researchers, this being such a complex area of medicine, we want to learn more about using and prescribing and managing medications.”
Dr. Dolovich and the researchers at TIPPS are excited by work that can have immediate application. “All of what we do impacts people directly. Our research is the kind that is actually going to help the people we meet every day. I think of my family, my parents, myself – all of the work we are doing is aiding in the transformation of healthcare right at the frontline.”