Pharmacy dean, medicine prof spread word on deprescribing
When you get a new prescription, your doctor is going to tell you when to take your medication and how often. But how do you know when it’s time to stop?
If your condition improves, you’ve got your answer.
But if your condition changes or a new problem develops, more medications may be prescribed, leading to a buildup of prescriptions over time. “That’s when things can become difficult for the patient,” said Dr. Lalitha Raman-Wilms.
Raman-Wilms, dean of the College of Pharmacy at Rady Faculty of Health Sciences, is also a pharmacist herself; she’s seen first-hand what happens when the medications meant to help start to become part of the problem.
During the early years of her career, Raman-Wilms worked in a long-term care facility in Thunder Bay where residents were often on a multitude of drugs for various conditions. “It wasn’t that unusual,” she recalls. But there was one patient that still stands out for her. “He was really passive and not able to do too many things for himself,” she said. “His family was very devoted and they came to see him regularly, but he never spoke.” Besides those visits, his life was limited to watching TV and not much else.
As a pharmacist, Raman-Wilms knew one way she could help was to review his medications to make sure they were being used correctly and effectively. That involved checking if he was taking the right amount of the correct medications, looking for any interactions between prescriptions and exploring better options for managing his conditions.
This process is called deprescribing – a full evaluation, changing or even removing medications. “Just because something was helpful at one point doesn’t mean it’s still helpful,” she said.
With careful monitoring and regular discussions with other health-care providers, the patient’s drugs were reduced again and again. One day, his family was astonished to hear him speak, something he hadn’t done in a decade.
“It’s never left my mind – we can do so much with medications to help patients, but we also need to think about when it’s time to reevaluate.”
Today, roughly 25 per cent of adults aged 65 or over are taking 10 or more medications at the same time. As dean of pharmacy, Raman-Wilms wants to ensure the next generation of pharmacists is ready for patients with multiple prescriptions, but she’s also keen to spread the word among other health professionals.
Raman-Wilms is a lead author on a recent article for Medical Science Educator that proposes a curricular framework for an interprofessional approach to deprescribing. She’s also authored a chapter on deprescribing for a new reference book, the Encyclopedia of Evidence in Pharmaceutical Public Health and Health Services Research in Pharmacy.
Other experts from Rady Faculty are also investigating this important facet of health care, including Dr. Alex Singer, associate professor of family medicine and director, Office of Research & Quality Improvement in the department and director, Manitoba Primary Care Research Network.
One study in progress is known as SPIDER: A structured process informed by data, evidence and research – a research and quality improvement collaboration supporting practices in improving care for complex elderly patients.
Not only does it explore some of the same points Raman-Wilms champions, such as patient safety, but it also looks at reducing risk and preventative care. Additionally, it explores the costs associated with polypharmacy.
“One thing to consider is that fewer people are showing up in the emergency department with adverse drug effects. First and foremost, that’s good for patients,” he said, adding that means less pressure on the system, which allows health-care professionals to work more effectively and incur fewer costs. “And that’s good for everyone.”
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