Seniors should get annual medication reviews in primary care: new guidelines

New guidelines on screening for potentially inappropriate prescribing recommend regular medication reviews in primary care for adults aged 65 years or older—regardless of the number of prescription medications they take.Provincial or territorial healthcare systems should pay for these reviews, the guidelines state. Those are the only two recommendations the guidelines make, but they are grounded in evidence. The recommendations don’t focus on a particular medication class but on any potentially inappropriate prescribing. This could include overprescribing, underprescribing, prescribing that involves interactions between medications and other inappropriate situations.Members of the Canadian Medication Appropriateness and Deprescribing Network (CADeN) created the guidelines, after the Canadian Task Force on Preventative Care selected the topic. The guideline authors include family physicians, geriatricians, pharmacists, patients and deprescribing experts. While the guidelines recommend a medication review, complete with suggestions by a pharmacist or a prescriber, they note it should have a structured approach or follow a set of rules. These inventions should take place every one to two years, or whenever there’s a substantial change in health status (e.g., hospital discharge, new diagnosis, etc.). It could be more frequent for people taking five or more medications. Without interventions such as a medication review, patients tend to continue to take potentially inappropriate medications, the guidelines note.The recommendations are for medication reviews carried out in primary care and not necessarily by community pharmacists. This is because the guideline authors made the recommendations based on results of more than 118 clinical trials, only 18 of which involved community pharmacies. “Our recommendation applies to the studied interventions, and not to independent reviews by community pharmacists,” the guideline authors write. “We make this distinction as there is limited evidence supporting the impact of community pharmacy medication reviews; however, we recognize there are different views on their merits.”Time is the main barrier to these interventions, specifically physician’s time. The guideline authors suggest a few solutions to this, including funding prescribers specifically for deprescribing and related care; “parachuting” clinical pharmacists into primary care teams or funding software that tackles inappropriate prescribing.Seniors should ask their primary care provider for a medication review or prescription checkup, suggested Dr. Emily McDonald, lead author of the guideline and associate professor of medicine at McGill University in a university press release.“Patients should understand their medications and feel empowered to ask whether non-drug options are possible,” she said. Dr. McDonald also directs the Canadian Medication Appropriateness and Deprescribing Network. It has a medication review service finder where people can find publicly funded medication review services from pharmacists or physicians.The guidelines list links to medication review tools for healthcare providers in the appendix. These include the STOPP/START criteria version 3 published in European Geriatric Medicine in 2023, the American Geriatric Society updated Beers criteria, the EU (7)-PIM list and others. The Canadian Geriatric Society also has links to many of these medication review tools on its website. The guidelines are in keeping with federal legislation. There’s a section in the federal Pharmacare Act that mandates Health Canada develop a pan-Canadian strategy on the appropriate use of prescription drugs and report on its progress. It was published in September 2025. The strategy also outlines inappropriate use of prescription medications.The guidelines were published in Canadian Family Physician.

Seniors should get annual medication reviews in primary care: new guidelines

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