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Heidi Wicks

Pharmacists often recommend medications to take, but they also suggest which ones may not be needed.

Approximately 30% of patients aged 65 years or older are prescribed five or more drugs.

An Australian study estimated approximately one in five drugs commonly used in older people may be inappropriate.  Such inappropriate medications have been linked to negative events like increased confusion and higher risk of falls. Preventing falls – particularly in the elderly – can improve quality of life and decrease health care costs immensely.

A new research study in the School of Pharmacy’s Medication Therapy Services (MTS) Clinic will partner with St. Patrick’s Mercy Home Long Term Care Facility to provide in-depth medication reviews for residents. The focus is on identifying duplicate, unnecesssary and potentially harmful medications.

Sleep aids, certain diabetes medications, antipsychotics overused

The Canadian Deprescribing Network (CaDeN) and the Canadian Institute of Health Information (CIHI) describes sleeping pills, stomach pills (PPIs), certain diabetes medications and antipsychotics as some common drugs that are used for longer than required.

Dr. Debbie Kelly, MTS Clinic director and associate professor with the School of Pharmacy, noted that in most cases, these medications provide important therapeutic value to a patient, however there are times when the initial reason they were prescribed has been resolved and continuing to take the medication is no longer required.

“Sleep aids, for example, are intended for short-term, intermittent use only,” explained Dr. Kelly. “Over time they lose their effectiveness and stop providing the relief they once did.” 

Every person has unique health and medication needs, she added. 

“We’re going to look at each resident individually, taking into consideration all of their health information and health goals in order to determine what is the best medication therapy plan for that person. They’re not just their diabetes or their heart disease.  Everyone’s health goals are different and we want to help develop a medication therapy plan that looks at the whole person.”

Renee King, resident care manager at St. Patrick’s, is excited for the initiative.

“We’re always striving to improve the care our residents receive and ensuring they are taking the right medications at the right time is a huge step toward achieving this goal,” she said. Our residents and families are looking forward to working closely with the project’s clinical pharmacists and pharmacy students in the hopes of improving their medication therapy and where possible, decreasing the number of medications they take.” 

Enriched teaching and learning and community engagement

Pharmacy students in their final semester of study will provide the medication reviews under the supervision of the pharmacist servicing the facility and clinical pharmacists in the MTS Clinic. They will then propose evidence-based, individualized plans to carefully and safely discontinue these medications.

“We educate our students to systematically assess each patient’s medication regime for appropriateness, effectiveness and tolerability,” said Dr. Kelly. “During the final year of their program they work with pharmacists to assess patients’ medication therapy for any drug therapy problems, including appropriateness of medications and indications for deprescribing, as part of their final training.”

The project will not only benefit pharmacy students, but also hopefully the residents of St. Patrick’s.   

Research methods/goals

“The project will initially provide deprescribing-focused medication therapy assessments to one half of the residents on the second floor of St. Pat’s by using a randomized, controlled study design.

“The other half of the residents on that floor will serve as the control group and continue as usual to receive their annual medication review and regular care from the attending physicians and nurses,” Dr. Kelly explained.

The goal is to evaluate whether the residents’ overall health and wellbeing is improved after unnecessary medications are removed and the doses of required medications are optimized.