Deprescribing
What is deprescribing?
- Process of stopping or reducing medicines
- with the aim of eliminating problematic (inappropriate) medicines
- then monitoring the individual for unintended adverse effects
What is problematic polypharmacy?
When multiple medications are prescribed inappropriately, or where the intended benefit of
the medication is not realised
Scenarios where we worry about polypharmacy?
Prescribing of medicines that are no longer clinically indicated or appropriate or
optimised for that person
benefit does not outweigh harm
Where the combination of multiple medicines has the potential to, or is causing
harm to the person
Why does polypharmacy exist? causes?
Multiple long-term conditions
Increasing age
new drugs
NHS guidance and targets (QOF, NICE quality standards)
Multiple prescribers
A “pill for every ill” and psychosocial issues
o e.g., diarrhoea as a side effect of a drug, so add a senna tablet to treat that
etc
o rather than determining the cause of the side effect and finding something
more suitable
Poor therapeutic goal setting
Patient or carer demand
Challenges to deprescribing
Fear of litigation
Poor evidence for stopping therapy
Non-adherence – “therapeutic failures”
o keep taking tablets after they are said to deprescribe
Poor communication and transfer of information
o e.g., between dentist, gynaecologist etc and GP
o takes time to send information
Poor medication review
Treating condition vs. person
Non-pharmacological options not readily available or accessed
o waiting for therapy appointments so tablets restarted
How do we calculate anticholinergic burden?
calculator
possible anticholinergic score 1
What is deprescribing?
- Process of stopping or reducing medicines
- with the aim of eliminating problematic (inappropriate) medicines
- then monitoring the individual for unintended adverse effects
What is problematic polypharmacy?
When multiple medications are prescribed inappropriately, or where the intended benefit of
the medication is not realised
Scenarios where we worry about polypharmacy?
Prescribing of medicines that are no longer clinically indicated or appropriate or
optimised for that person
benefit does not outweigh harm
Where the combination of multiple medicines has the potential to, or is causing
harm to the person
Why does polypharmacy exist? causes?
Multiple long-term conditions
Increasing age
new drugs
NHS guidance and targets (QOF, NICE quality standards)
Multiple prescribers
A “pill for every ill” and psychosocial issues
o e.g., diarrhoea as a side effect of a drug, so add a senna tablet to treat that
etc
o rather than determining the cause of the side effect and finding something
more suitable
Poor therapeutic goal setting
Patient or carer demand
Challenges to deprescribing
Fear of litigation
Poor evidence for stopping therapy
Non-adherence – “therapeutic failures”
o keep taking tablets after they are said to deprescribe
Poor communication and transfer of information
o e.g., between dentist, gynaecologist etc and GP
o takes time to send information
Poor medication review
Treating condition vs. person
Non-pharmacological options not readily available or accessed
o waiting for therapy appointments so tablets restarted
How do we calculate anticholinergic burden?
calculator
possible anticholinergic score 1
