For Patient Safety Week, taking place from October 29 – November 2, we will be sharing a two-part series on this year’s theme Not All Meds Get Along. Many CHÉOS researchers are working to improve patients’ experiences with the health care system. The first part of our series will look at the issue of polypharmacy, highlighting the research of CHÉOS Scientist Dr. Rita McCracken.
Two out of three Canadians over the age of 65 take 5 or more different prescription medications and over a quarter take at least 10. As more Canadians are living longer, many are also living with multiple chronic conditions that are managed with multiple medications. Patients are often prescribed medications but are never taken off of them even though they are no longer needed and over time these medications accumulate. Though there is no agreed upon definition, polypharmacy, broadly speaking, is a term used to describe situations where more medications are being prescribed to a patient than is clinically indicated.
Dr. Rita McCracken is a family physician, CHÉOS Scientists, and PhD candidate who recently defended her thesis on the associations between intensity of treatment of asymptomatic disease, like hypertension, and polypharmacy in people over the age of 70. Simultaneously taking multiple medications, termed polypharmacy, can pose risks to patients as a result of the drugs interacting with one another, with other conditions that they are not indicated for, or because medications are deemed inappropriate for the patient due to additional harms they cause. Treatment guidelines for asymptomatic disease are often based on studies done in younger, healthier patients meaning that there is sparse information about how medications are being used among older patients facing either multiple health issues or a natural death. Older patients may be at higher risk of falls, adverse drug reactions, increased length of stay in hospital, hospital readmission, and mortality.
In order to get a better understanding of why patients end up on so many medications, Dr. McCracken and researchers from UBC and the University of Alberta examined one possible factor contributing to polypharmacy in a paper published last summer. The study looked specifically at whether higher intensity treatment for common chronic conditions like diabetes and hypertension could be associated with polypharmacy in nursing homes. Using surrogate outcomes like blood pressure and blood sugar level, the researchers assessed whether patients were being over-treated for these chronic conditions.
They found that diabetes and hypertension were frequently overtreated in nursing home patients. For blood sugar levels, and to some extent blood pressure, lower surrogate levels were associated with more medications, signalling that treatment intensity could be a driver of polypharmacy. This finding shifts the focus of improving medication safety from reducing the absolute number of medications a patient is on or preventing the use of drugs that are typically considered inappropriate for older patients to how commonly used medications are prescribed and under what circumstances. In this way, the study emphasized the need for specific medication guidelines for frail patients.
In Dr. McCracken’s early research, which involved surveying family physicians in Vancouver about their deprescribing practices, she found that there are barriers to deprescribing and inconsistent approaches to tackling the problem. Identifying evidence-based ways to reduce polypharmacy to prevent medication complications is needed. Patient Safety Week is advocating for patients and health care providers to engage in conversations about reviewing patients’ medications, particularly for those over 70 years of age or those taking over 5 medications. Dr. McCracken contributed to the development of an electronic tool to help initiate this process, which is being tested by CHÉOS Scientists Drs. Anita Palepu and Nadia Khan and will be described in Part 2 of this series.