Therapeutics Initiative takes aim at multiple prescriptions

PharmacyUBC’s Therapeutics Initiative (TI) is urging physicians to adopt a “common sense” and “Golden Rule” approach when prescribing drugs, to minimize “polypharmacy” — the use of multiple drugs simultaneously.

In its latest Therapeutics Letter, the advisory group suggests that physicians always look to prune the list of medications their patients are taking, so as to minimize harmful reactions and save money for both the patient and society.

“Rational prescribing requires restraint and wisdom in initiating chronic drug therapy, but also fundamental change in our philosophy of medicinal care,” says the Therapeutics Letter, which is sent to prescribing physicians and pharmacists throughout British Columbia.

Therapeutics Letters summarize evidence from drug trials and other types of studies, and are reviewed by 60 experts and primary physicians before publication.

The TI notes that B.C. has the lowest average per capita drug costs, due mostly to lower consumption of multiple drug classes.

“However, there is little reason for complacency,” the letter states.

The TI calls on physicians to routinely challenge  complex medication regimes, and to lean toward simplification when it can improve patients’ health. It then provides seven steps that doctors, pharmacists, nurses, patients and their families can use to help in “deprescribing”:

1. Always keep in mind the goal of the therapy. If a drug given to treat symptoms doesn’t improve the quality of a person’s life in a short time, it should be discontinued. If a drug is prescribed as a preventative measure, always consider the drug’s adverse effects and cost.

2. Understand the real evidence from randomized controlled trials.

3. Consider simple pharmacology and physiology to either reduce dosage or end its use entirely.

4. Consider the cost of the drugs, and if pressed for time during a patient encounter, focus the discussion on the most expensive ones.

5. Constantly re-assess whether drugs prescribed for a temporary condition can be discontinued.

6. Health professionals should ask themselves, “Would I take this drug under these circumstances?”

7. Aim to stop at least one drug.

Therapeutics Letters, along with the TI’s other work, is funded by the B.C. Ministry of Health through a grant to UBC. The TI provides evidence-based advice about drugs but is not responsible for provincial drug policies.

This and other Therapeutics Letters are available online.