As we age, many of us develop health issues that need ongoing treatment. Thanks to modern medicine there are drugs to help, but taking multiple medications at the same time can be problematic; drugs can interfere with each other, and the wrong combinations can also cause harm.
Currently, 40% of older adults take five or more medications daily. This ‘polypharmacy’ is not only costly, but can also cause dangerous side effects among vulnerable seniors. Making sure all medications are both required and safe is an important part of ongoing care. But it’s not a simple task.
Of course, there are comprehensive resources that outline drug interactions and potentially harmful combinations. But these manual resources are complicated and time-consuming to use, especially for patients on 10 or more drugs. Plus, withdrawing a medication is a big decision.
To address this problem, researchers at McGill University Health Centre have created and tested MedSafer, an automated decision support tool that checks all the medications prescribed to a patient and offers a recommendation of whether any can be safely stopped or reduced.
Working in teaching hospitals in Montreal, Ottawa and Toronto, the research team tested MedSafer with 1,066 patients aged 65 and older, all taking five or more regular medications.
On admission to hospital, MedSafer identified potentially inappropriate or harmful medication in the vast majority (82%) of participants. Of these individuals, half went on to receive usual care (i.e. their clinicians did not receive a MedSafer report). The other half were assessed with the help of MedSafer, with clinical teams free to decide how best to use the information provided.
At the time of discharge, more patients in the MedSafer group had a medication de-prescribed (54.7% vs. 46.9%). A month later, there was no increase in adverse events as a result of these changes.
It might not seem like the most dramatic change, but the researchers suggest that the impact could be higher when used in less specialized environments such as long-term care homes. In fact, long-term care units in New Brunswick and Ontario are already integrating it into the care pathway.
“A prescription check-up is a complex process for interprofessional teams and often involves complicated decision-making,” explains first author Dr. Emily McDonald, a scientist and physician at McGill University Health Centre.
MedSafer makes the process easier and quicker, helping doctors and pharmacists review medications that might be problematic so seniors can maintain their independence, mobility, and cognition.