Deprescribing Guide: Starting the Crucial Conversation

At BetterRX, we understand the intricate dynamics that exist between patients, their caregivers, and their medication regimens. A person's health and well-being are of utmost importance, but medications meant to ensure this well-being can sometimes become a burden. This is especially true for those dealing with long-term health conditions. This leads us to 'deprescribing,' which is an integral part of patient care.

Understanding Deprescribing

Deprescribing refers to the process of discontinuing or modifying a medication regimen. Though beneficial, this process can be tricky to discuss with patients and their caregivers. Many patients have been on their medications for extended periods or have been informed about the benefits these medicines provide by their primary care providers or local pharmacists.

Any conversation about deprescribing can be misunderstood as giving up on the patient or trying to save money. Therefore, healthcare providers must communicate the reasons for such modifications empathetically, giving patients and their caregivers enough time and space to process this information and express any concerns.

The Pill Burden: Addressing Polypharmacy

Polypharmacy, which refers to the practice of taking more than 3-5 medications daily, can significantly affect a patient's quality of life. Complicated regimens involving multiple prescriptions can increase the risk of side effects, necessitating additional medications to manage these adverse effects. This pill burden not only diminishes the patient's quality of life but also increases the complexity and potential confusion of adhering to their medication routines.

The Path To Reducing Pill Burden

The first step towards reducing pill burden is to assess the patient's adherence to their current medication regimen. This involves collecting and reviewing the patient's comprehensive medication list and their compliance with each prescribed medication.

The next step, addressing adherence, involves discussing the reasons behind any non-compliance. If a patient is not taking a medication as prescribed due to concerns about side effects, lack of perceived benefit, or fatigue from taking too many medications, deprescribing may be considered.

Simultaneously, it is important to reassess the need for each prescribed medication continually. If a medication is being taken more for prevention than palliation, stopping it could be a viable option.

Finally, when planning the process of deprescribing, it is beneficial to consider the availability of non-pharmacological options and the potential simplification of the dosing schedule. Long-acting options should be given preference wherever possible, as this can reduce the need for prn/breakthrough doses.

Deprescribing, when done correctly, can greatly improve the quality of life for patients dealing with chronic health conditions. It is not an attempt to withdraw care but a measure to refine it, making medication management more effective and less burdensome.

Our team has put together this visual guide for you below so that it may help provide insight into where the patient is in their understanding of the prognosis and how to best support them moving forward:

References:
1. Mohammed M, Moles R, Chen T. Medication-related burden and patients’ lived-experience with medicine: a systematic review and metasynthesis of qualitative studies. BMJ Open 2016;6(2):e010035 Available at http://bmjopen.bmj.com/content/6/2/e010035. info Accessed December 14, 2022
2. Leslie R, Erickson S, Patel B. Patient characteristics and medication burden affect adherence among seniors. Am JPharm Benefit 2014; Available at http://www.ajpb.com/journals/ajpb/2014/ajpb_julyaug2014/patient-characteristicsand-medicationburden-affect-adherence-among-seniors Accessed December 14, 2022
3. Rochon P, Gurwitz J. Optimizing drug treatment for elderly people: the prescribing cascade. BMJ1997:315(7115):1096-1099. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2127690/ Accessed December14, 2022
4. National Council on Patient Information and Education (NCPIE). Polypharmacy – America’s other drug problem.NCPIE http://www.bemedwise.org/talk-about-your-medicines-month/2016 Accessed December14, 2022
5. Garfinkel D. Poly-de-prescribing to treat polypharmacy: efficacy and safety. Ther Adv Drug Saf 2018;9(1):25-43
6. Farrell B, Merkley V, Ingar N. Reducing pill burden and helping with medication awareness to improve adherence, Can Pharm J 2013;146(5):262-269 Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3785195/ Accessed December14, 2022
7. Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults. Arch Intern Med 2010;170(18):1648-1654 

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BetterRX's mission is to radically change patient care by ending medication delays that cause needless suffering. BetterRX offers efficient ordering technology, medication tracking, real-time PPD & cost alerts, and committed local pharmacies. Learn more about BetterRX, our ConnectedRX technology, what makes us Better than a PBM, and our Pharmacy partnerships.