D2D eBulletin #87- Sometimes Less is More: Deprescribing initiatives in Primary Care

In this issue

• Deprescribing initiatives in interprofessional primary care teams
• AFHTO 2019 conference
• Stay tuned for resources to support your team’s QIP!

Deprescribing Initiatives in Interprofessional Primary Care Teams

What is deprescribing?
Deprescribing is the planned and supervised process of dose reduction or stopping of medication that might be causing harm, or no longer be of benefit. The ultimate goal of deprescribing is to reduce medication burden and improve quality of life¹.

Why is it important?
Deprescribing can improve patient health outcomes. It’s a method to address polypharmacy, which can be defined by the concurrent use of 5 or more medications (including both prescription and non-prescription products) by a single individual^1,2. Polypharmacy is common among seniors and individuals with mental health disorders³. This increases the risk of these populations experiencing an adverse drug effect and interactions that can contribute to negative outcomes².

How can it contribute to cost savings?
Inappropriate use of medication costs the Canadian healthcare system an estimated $419 million annually and the cost of treating the harmful effects of these medications is estimated to be $1.4 billion every year⁴. Deprescribing can help to reduce some of these unnecessary costs.

How can I get started?

• Check out the Canadian Deprescribing Network which has a variety of tools and resources for healthcare providers and patients.
• Check out deprescribing.org  for evidence-based guidelines for deprescribing and links to other research and projects involving deprescribing.
• Choosing Wisely has primary care specific deprescribing toolkits for benzodiazepines and protein pump inhibitors (PPIs).
  • Click here to access the benzodiazepines and sedative-hypnotics toolkit.
  • Click here to access the PPI toolkit.
  • Choosing Wisely also recently released Opioid Wisely, a campaign that encourages thoughtful conversation between clinicians and patients to reduce harms associated with opioid prescribing. Click here to access the Opioid Wisely resources.
• Click here to access AFHTO’s Partnered Supports for Chronic Pain and Addictions Resource page, which lists program of supports to help clinicians manage their patients’ pain, including appropriate use of opioids.

Learn how AFHTO members are implementing interdisciplinary deprescribing initiatives in their teams:

• PPI DE-PRESCRIBING PROJECT – Where we came from, where we are at now, where we are going, Credit Valley FHT
• An Interdisciplinary Approach to Deprescribe Sedative-Hypnotics in Elderly Patients, North York FHT
• When Things Aren’t Adding Up, Start Subtracting! De-Prescribing Sedative-Hypnotics, Taddle Creek FHT
• The HARMS Program for Safer Opioid Prescribing through Systematic Risk Stratification and Urine Drug Testing, Marathon FHT
• Managing and Mitigating Low Back Pain and Opioid Use In Interprofessional Teams: The Primary Care Low Back Pain Pilots, Belleville NPLC, Mount Forest FHT, Mount Forest Chiropractic, Impact Physiotherapy

Email improve@afhto.ca if you would like to get in contact with any of the teams above to learn more about their programs.

AFHTO 2019 Conference

Here are some important dates relating to this year’s AFHTO conference taking place September 19 & 20.

• Late May 2019: Concurrent sessions + posters selected + scheduled
• End of May to early June: Call for Bright Lights nominations
• June 2019: Conference registration opens
• September 4, 2019: Early-bird registration ends
• Sep 19 & 20, 2019: AFHTO 2019 Conference

Stay Tuned for Resources to Support your Team’s QIP!

The 2019/20 QIPs have been submitted and are available on the QIP navigator for review. You can search the 2019/20 QIPs using QIP Query or download any organization’s QIP using Download QIPs.

Stay tuned for resources and tools AFHTO will be providing to help teams once emerging themes are identified.

References:

1. Canadian Deprescribing Network: https://www.deprescribingnetwork.ca/deprescribing
2. ISMP Canada Safety Bulletin: https://www.ismp-canada.org/download/safetyBulletins/2018/ISMPCSB2018-03-Deprescribing.pdf
3. Sivagnanam G. Deprescription: the prescription metabolism. J Pharmacol Pharmacother. 2016;7(3):133-137.
4. Medication without harm. WHO global patient safety challenge. Geneva (Switzerland): World Health Organization; 2017 [cited 2018 Jan 31]. Available from: http://apps.who.int/iris/bitstream/10665/255263/1/WHO-HIS-SDS-2017.6-eng.pdf?ua=1&ua=1

In Case You Missed It: Check out eBulletin #86 or other news here!
Questions? Comments? Contact us at improve@afhto.ca.