McGill University researchers have developed and are licensing a digital tool to help safely reduce patients' use of medications that may be unnecessary or even harmful to them.
When clinicians review a patient's file, MedSafer flags potentially inappropriate medications. In a new clinical trial, the software helped deprescribe such medications in 36 per cent of long-term care residents, nearly triple as many as when reviews were done without the tool.
"Sometimes we blame aging for memory loss or mobility issues when the real culprit is the medications," said lead author Dr. Emily McDonald, Associate Professor in McGill's Department of Medicine, Scientist at the Research Institute of the McGill University Health Centre (The Institute) and attending physician at the McGill University Health Centre. "I've seen patients go from barely responsive to having conversations again after stopping a sedating medication."
Nearly two thirds of Canadian seniors take five or more medications a day, and the number is significantly higher in long-term care, she added.
How the tool fits into routine care
Medications are typically reviewed every three months in long-term care homes, but the scholars say there's no standard approach to deprescribing.
MedSafer works as a checklist for clinicians. It scans a resident's medication list alongside their health conditions, flags drugs that may no longer be appropriate and provides guidance on how to stop some medications or for safer alternatives.
The software was co-developed by McDonald and Dr. Todd Lee, Associate Professor in McGill's Department of Medicine and Scientist at The Institute . The trial involved 725 residents in five long-term care homes in New Brunswick who were taking an average of 10 medications each.
The problem with 'prescribing cascades'
Medications often accumulate over time and are sometimes prescribed to counteract the side effects of other drugs, a pattern known as a "prescribing cascade."
"Some medications can increase the risk of falls, confusion and hospitalizations," said Lee. "The more you take, the more side effects and interactions you can have."
The researchers' goal is to see MedSafer integrated into primary care, so that overmedication can be addressed before patients enter long-term care.
"This should be the new standard of care for older adults," McDonald said. "No one should be on a medication that's doing more harm than good."
About the study
"Electronic Decision Support for Deprescribing in Older Adults Living in Long-Term Care" by Emily McDonald and Todd Lee et al. was published in JAMA Network Open.
The research was funded by the Healthy Seniors Pilot Project, a joint initiative of the Public Health Agency of Canada and the Government of New Brunswick.
McDonald and Lee are co-founders of MedSafer Corp., which licenses the software used in the study.
