UofT, Canada’s Drug Agency and ISMP Canada collaborate on a new toolkit for polypharmacy

Polypharmacy, taking five or more medications, is a major health risk with major complications. It’s extremely common: research from the Canadian Institute for Health Information found that 62% of older adults were taking five or more medications in 2021. And while there are certainly times where more than one medication needs to be prescribed, polypharmacy “has impacts for people, health systems and the planet,” says Lisa McCarthy, associate professor at the University of Toronto’s Leslie Dan Faculty of Pharmacy. “We know that the more medications that someone takes, the risk of things like adverse drug events, drug interactions, falls, fractures, hospitalizations also increases.” That’s why deprescribing is a good part of prescribing, McCarthy, who is also the co-director of deprescribing.org, explains. And it’s why clinicians need to be having conversations with patients about medications—to ensure that the medications are still working without unintended effects. Alongside Canada’s Drug Agency (CDA-AMC) and the Institute for Safe Medication Practices Canada (ISMP Canada), McCarthy and her team discovered that clinicians—everyone from doctors to nurse practitioners to pharmacists—need support in having these conversations. So, the groups came together and collaborated to create a toolkit for deprescribing. McCarthy explains that the toolkit has five tips that are designed to make it easier for clinicians to address polypharmacy in their practices and optimize medication use. “The toolkit explains each tip and provides a short list of carefully chosen resources where people can go and consult to learn more,” she explains. Tips include documenting the reason for use when prescribing, conducting medicine reviews and consider deprescribing. These tips and conversation started with patients are designed to share information and help practitioners get a holistic view of the medications being taken. “We can’t go as far as saying, ‘here’s how to operationalize it,’ but we can give suggestions,” McCarthy says. “The intention was to put forth some tips that are grounded in evidence for people to think, ‘how can I do this in my practice?’”Another problem the toolkit is trying to solve for is the fact that typically the only person who knows what medications a patient is on is the patient themselves and their caregiver Because there are multiple prescribers in our healthcare system, as well as popular supplements and vitamins that patients often take, there isn’t one centralized place for prescriptions. The toolkit also includes tips for patients, which clinicians can share with them. Empowering patients to create and share their medications list is a big part of the puzzle, McCarthy says. “It’s really powerful for patients to know there isn’t a centralized list and that they are the custodians of that list,” she says. “I think that helps to change the conversation.”The collaboration came about after the CDA-AMC began work surrounding appropriate use of medications, like defining situations where patients, caregivers and health professionals should work together and choose safe and effective medications. At the same time, ISMP Canada’s original “five questions to ask about medications” tool which has been used around the world. McCarthy said that following up that tool with tips for clinicians on managing these situations would be useful, and that’s how the deprescribing toolkit came together, with her and her team at the UofT leading clinician consultations and developments. During the consultations, McCarthy and her team worked to figure out exactly how clinicians would use the toolkit. “We’re trying to start a thinking process and a conversation amongst clinicians about how they can implement these things into their practice,” she says. The resulting toolkit is a reminder for clinicians—new and old—about small things they can do to prevent polypharmacy. “It was co-designed with the people that are intended to use it so it’s practical,” she says. “If we can get patients to come in and book appointments where they’re asking questions about their medications, how powerful i that as a clinician to have that door open where your patient is signalling to you that they want to have a conversation?” McCarthy says. “That’s really what we’re hoping this campaign will do: help patients feel like they know what questions to ask and help providers feel like they have things in their everyday practice that are realistic that can help move the needle on addressing appropriate use of medications.” Clinicians can check out the toolkit here and patients can check out a companion resource, “5 questions to ask about my multiple medications” here.

UofT, Canada’s Drug Agency and ISMP Canada collaborate on a new toolkit for polypharmacy

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