The over-use of medication by seniors is a significant challenge. Most recently, a report by BC’s Seniors’ Advocate finds that more than a third of seniors in long term care facilities in BC are prescribed antipsychotic drugs.
Doctors of BC and the provincial government have been working together through the Shared Care Committee on a project to help reduce the amount of medication prescribed to seniors. The initiative started in eight residential care centers and is about to be expanded province-wide. Antipsychotics and antidepressant are two of the drug classes examined.
How does the Polypharmacy Risk Reduction initiative work?
It supports doctors, other health care professionals, patients and their families to improve the management of multiple medications through a number of measures. Its goal – first and foremost – is about improving the safety and quality of life of patients. And collaboration is the key to success.
The approach includes:
- Enhanced Medication reviews within the circle of care: A multidisciplinary approach involving physicians, pharmacists, care facility staff, the resident, and family members collaborating to design processes and implement strategies for polypharmacy risk reduction for each resident. Residents’ family members play an important role when it comes to identifying adverse drug events and reporting improvements. Enhanced medication reviews followed by close monitoring supported the safe discontinuation of medications. For example, in a Chilliwack site, 194 medications were successfully discontinued for 90 residents.
- Involvement of patients and their families: Providing education and support for residents and family members to inform medication-related decisions is a key activity moving forward.
- Clinical resources materials: Materials previously reviewed by an expert clinical advisory group provide the best evidence-based information to inform the medication review process and decision making. The materials are continually modified and improved in response to feedback from the field. In the prototype centres, these clinical resource materials proved to be beneficial in helping to make the best decisions around medication. Care providers reported increased knowledge and better strategies on the best approach to medication for patients.
- Workshops: Through a series of local workshops, physicians receive information and tools to facilitate polypharmacy risk reduction in their own care settings. A train-the-mentor program has been developed and will be expanded across the province to foster physician to physician mentoring in PRR.
The results of the first phase of the initiative are encouraging. In the pilot project phase, it has reduced the number of prescriptions for seniors in the pilot project sites, and we have anecdotal reports of residents who are more alert and active. Team work among health care professionals and peer mentoring are enhanced. We look forward to expanding the project to other facilities.
The Polypharmacy Risk Reduction Initiative is one example of how the collaborative programs of Doctors of BC and the BC government are working to make a positive difference for patients, and for our health care system.