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By Heidi Wicks

Pharmacists often recommend medications to take, but they also suggest which ones to take away.

Approximately 30 per cent of patients aged 65 years or older are prescribed five or more drugs; an Australian study estimates approximately one in five drugs commonly used in older people may be inappropriate.

Such inappropriate medications have been linked to negative events like increased confusion and higher risk of falls. Preventing falls — particularly in the elderly — can improve quality of life and decrease health-care costs immensely.

Sleep aids, diabetes meds, antipsychotics overused

As such, a new research study in the School of Pharmacy’s Medication Therapy Services (MTS) Clinic will partner with Lawton’s Nursing Home Services and St. Patrick’s Mercy Home long-term care facility to provide in-depth medication reviews for residents.

The focus is on identifying duplicate, unnecessary and potentially harmful medications.

“Over time, they lose their effectiveness and stop providing the relief they once did.” — Dr. Debbie Kelly

The Canadian Deprescribing Network (CaDeN) and the Canadian Institute of Health Information (CIHI) describes sleeping pills, stomach pills (PPIs), certain diabetes medications and anti-psychotics as some common drugs that are used for longer than required.

Dr. Debbie Kelly, MTS Clinic director and associate professor, School of Pharmacy, notes that in most cases, these medications provide important therapeutic value to a patient.

Dr. Debbie Kelly
Dr. Debbie Kelly
Photo: David Howells

However, there are times when the initial reason the medications were prescribed has been resolved and continuing to take the medication is no longer required.

“Sleep aids, for example, are intended for short-term, intermittent use only,” explained Dr. Kelly.

“Over time, they lose their effectiveness and stop providing the relief they once did.”

Right meds, right time

Renee King, resident care manager at St. Pat’s, says she is excited the initiative is happening at her facility.

She says she and her staff always strive to improve the care their residents receive at the home.

“Ensuring they are taking the right medications at the right time is a huge step toward achieving this goal,” said Ms. King.

“Our residents and families are looking forward to working closely with the project’s clinical pharmacists and pharmacy students in the hopes of improving their medication therapy and where possible, decreasing the number of medications they take.”

From left are Beverly Noftall, pharmacy student Tiffany Tozer and Mary Stokes. Ms. Stokes is Ms. Noftall's mother.
From left are Beverly Noftall, pharmacy student Tiffany Tozer and Mary Stokes. Ms. Stokes, a resident of St. Patrick’s Mercy Home, is Ms. Noftall’s mother.
Photo: Chris Hammond

Dr. Kelly says that every person has unique health and medication needs, and the study will allow the research team to look at each resident individually and take into consideration all of their health information and health goals in order to determine what is the best medication therapy plan for that person.

“They’re not just their diabetes or their heart disease. Everyone’s health goals are different and we want to help develop a medication therapy plan that looks at the whole person.”

Enriched teaching and learning and community engagement

Pharmacy students in their final semester of study will provide the medication reviews under the supervision of the pharmacist servicing the facility and clinical pharmacists in the MTS Clinic.

Pharmacy student Tiffany Tozer and Margaret Reid, a resident of St. Pat's.
Pharmacy student Tiffany Tozer and Margaret Reid, a resident of St. Pat’s.
Photo: Chris Hammond

They will then propose evidence-based, individualized plans to carefully and safely discontinue any medications.

“We educate our students to systematically assess each patient’s medication regime for appropriateness, effectiveness and tolerability,” said Dr. Kelly.

“During the final year of their program they work with pharmacists to assess patients’ medication therapy for any drug therapy problems, including appropriateness of medications and indications for deprescribing, as part of their final training.”

Research methods/goals

The project will initially provide deprescribing-focused medication therapy assessments to one half of the residents on the second floor of St. Pat’s by using a randomized, controlled study design.

The other half of the residents on that floor will serve as the control group and continue as usual to receive their annual medication review and regular care from the attending physicians and nurses.”

The goal is to evaluate whether the residents’ overall health and well-being is improved after unnecessary medications are removed and the doses of required medications are optimized.

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