By Rajan Anand
Imagine you take seven medications a day, and have done so for years. Increasingly, you find yourself groggy during the day, and your memory feels murky. One day you become disoriented and fall, winding up in the ER. A hospital pharmacist takes your medication history and discovers that the drugs you were prescribed years ago are actually to blame for the fall, the memory loss, and the grogginess. It turns out you no longer needed to be taking these medications, and their side effects had been compromising your quality of life for years.
An increased likelihood of falls, ER visits, adverse drug events, medication interactions, and even death: These are risks associated with polypharmacy, or the concurrent use of 5+ medications. In addition to endangering patients, the negative effects of inappropriate medication use place an enormous economic burden on the Canadian healthcare system as patients take medications that (at best) may not be needed and that (at worst) land them in the hospital.
As trusted medication experts, hospital pharmacists are well positioned to play an active role in changing Canadian prescribing culture. Hospital pharmacists are trained to systematically identify which drugs should be discontinued for a given patient, spotting situations when the potential harm from a drug outweighs its potential benefits. The pharmacist takes into account the context of the patient’s care goals and preferences, and supports the safe, effective use of medication.
In Canada, harm from polypharmacy largely impact adults over 65 years of age, whose risk of medication-related harm is estimated at 5 times that of younger people. Compared to youth, seniors on average are prescribed more medications, have been on medications longer, and experience physiological changes that place them more at risk of experiencing side effects from drugs. Hospital pharmacists pay particular attention to older adult populations when they are admitted to, transferred within, or discharged from the hospital, as these are optimal times to start a deprescribing initiative if needed.
Deprescribing interventions are collaborative in nature. Pharmacists work alongside prescribers and the interdisciplinary care team to identify drugs that aren’t necessary. They engage the patient and their caregivers in the process, making sure that the patient’s preferences and goals are heard. Hospital pharmacists also communicate with community partners to ensure continuity of care after the patient leaves the hospital. By working collaboratively, interprofessional healthcare teams can leverage medication expertise to reduce inappropriate polypharmacy and improve health outcomes.
Rajan Anand is a University of Saskatchewan PharmD class of 2022 graduate. Driven by his passion for pharmacy, he takes pride in delivering the best patient centered care possible.
