New toolkit guides clinicians through conversations about polypharmacy

Polypharmacy – often defined as taking five or more medications – is a significant health issue, particularly for older adults. Research from the Canadian Institute for Health Information shows that 62 per cent of older adults were taking five or more prescription medications in 2021.

In some cases, patients need to be on multiple medications to manage complex conditions. But in other cases, some of the medications may be unnecessary.

And all this medication use can have negative effects: Not only does it increase health care spending and waste, but drug interactions and side effects can increase a patient’s risk of falls, fractures, cognition problems, and hospitalizations.

“Medicines are an important part of how we achieve health, but it’s critical that they are used appropriately,” says Lisa McCarthy, associate professor at the Leslie Dan Faculty of Pharmacy and co-director of deprescribing.org, a research team whose website hosts deprescribing guidelines, related research and tools to help people make decisions about medications. “The goal for medication use is that people get the medicines they need – no less, no more.”

“The goal for medication use is that people get the medicines they need – no less, no more.”

Health organizations such as Canada’s Drug Agency (CDA-AMC) and the Institute for Safe Medication Practices Canada (ISMP Canada) have recently undertaken campaigns to prioritize appropriate use of medications and help patients have conversations with their health care providers about polypharmacy and their medications. McCarthy and her team identified that many clinicians need support in having these conversations.

Working with CDA-AMC, ISMP Canada and primary care providers, she and colleagues from deprescribing.org developed an easy-to-use tool for clinicians to answer questions from and facilitate conversations with their patients about their medication use. This tool, “5 Tips to Manage Polypharmacy,” is now available through deprescribing.org and the CDA-AMC website.

The tool and an associated toolkit were developed in collaboration with more than 25 primary care clinicians, including physicians, pharmacists, and nurse practitioners, and with organizations such as Choosing Wisely Canada and the College of Family Physicians of Canada.

“The tool was developed with and for primary care providers,” says McCarthy. “It provides practical, realistic tips that are evidence-based best practices and based in the Canadian context for primary care.”

The toolkit provides recommendations for managing a patient’s medications, including documenting the reason for starting a medication, conducting medication reviews, and considering deprescribing. It also contains curated lists of resources to support clinicians with managing polypharmacy.

It emphasizes the importance of collaboration among health care providers , but also the importance of working with patients.

“There is no one way that information about medication changes gets shared. The onus is on patients to keep updated lists of medications and know the rationale for medication decisions, but they often don’t know that this is needed,” says McCarthy.

“As clinicians, we can support patients in maintaining their list of medications and document the reasons for medications, and work with their other health care providers to review what people are taking and why, and consider deprescribing if appropriate. The best plan is the one where everyone knows what is happening.”

The “5 Tips to Manage Polypharmacy” tool and toolkit are available through deprescribing.org and the CDA-AMC website. A companion resource for patients, “5 Questions to Ask about My Multiple Medications,” is available through ISMP Canada.