Volume 202 - Issue 4
First do no harm: a real need to deprescribe in older patients
Authors: Lisa Kouladjian, Timothy F Chen and Sarah N Hilmer
Med J Aust 2015; 202 (4): 178-179. || doi: 10.5694/mja14.01486
Published online: 2 March 2015
Published online: 2 March 2015
Medication reviews and multidisciplinary input prevent harm
We enthusiastically welcome Scott and colleagues' article highlighting the real need to deprescribe in older patients;1 however, we would like to emphasise the role of validated tools and medication management reviews in deprescribing.
Validated tools help clinicians identify potentially inappropriate medications. Scott et al state that medications whose benefits are outweighed by harm in most circumstances, such as potent opioids, anticholinergics and benzodiazepines, account for relatively few adverse drug events (ADEs) in Australian practice. This is potentially misleading, as it relies on practitioners or consumers recognising ADEs. Recognising ADEs is relatively simple when anticoagulants cause bleeding, but more subtle ADEs, such as functional impairment from anticholinergic and sedative medications, are often not recognised and are misattributed to ageing or multimorbidity. Therefore, validated tools for recognising high-risk medicines are an important component of medication management reviews.
We agree that input from appropriately trained (accredited) pharmacists and other health care professionals with expertise in the clinical use of medicines has been shown to be beneficial for deprescribing practice. We wish to highlight the value of medication management reviews, such as Home Medicines Review (HMR) and Residential Medication Management Review (RMMR), which involve pharmacists and general practitioners in the deprescribing process. This kind of multidisciplinary model has been shown to be effective in reducing polypharmacy.2
In Australia, recommendations provided by pharmacists as part of the HMR/RMMR service reduce exposure to anticholinergic and sedative medications.3,4 Accredited pharmacists have excellent medication knowledge and communication and education skills that are highly valued by patients.5
Competing interests
No relevant disclosures.
References
- Scott IA, Anderson K, Freeman CR, Stowasser D. First do no harm: a real need to deprescibe in older patients. Med J Aust 2014; 201: 390-392. 1
- Gnjidic D, Le Couteur DG, Kouladjian L, Hilmer SN. Deprescribing trials: methods to reduce polypharmacy and the impact on prescribing and clinical outcomes. Clin Geriatr Med 2012; 28: 237-253. 2
- Nishtala PS, Hilmer SN, McLachlan AJ, et al. Impact of residential medication management reviews on drug burden index in aged-care homes: a retrospective analysis. Drugs Aging 2009; 26: 677-686. 3
- Castelino RL, Hilmer SN, Bajorek BV, et al. Drug Burden Index and potentially inappropriate medications in community-dwelling older people: the impact of Home Medicines Review. Drugs Aging 2010; 27: 135-148. lefthere
- Carter SR, Moles R, White L, Chen TF. Exploring patients' motivation to participate in Australia's Home Medicines Review Program. Int J Clin Pharm 2012; 34: 658-666. 5