Polypharmacy has been described as a severe and ongoing problem. Anecdotal evidence and results from studies abound as to patients whose quality of life improved after being taken off of multiple chronic medications that cause side effects such as dizziness, nausea, drowsiness, orthostatic hypotension, coughing, and hallucination on a near-constant basis for some patients. The results of polypharmacy can not only be deleterious to quality of life, but even have serious implications for more immediate clinical parameters and iatrogenesis. Deprescribing is a growing movement aimed to address polypharmacy with evidence-based, systematic means of removing certain medications from a patient’s therapeutic regimen.
Conklin et al wrote about the barriers and facilitators to implementing deprescribing guidelines on the front line of clinical practice.1 Barriers included resistance to deprescribing for fear that the original prescriber’s authority and expertise were being questioned, that: the removal of medications was seen as “trying less” for the patient, pharmacists and pharmacies are reimbursed based on volume of prescriptions filled, the medical (and health) industries are saddled with a “prescribing culture”, and policies and procedures for deprescribing are lacking in most organizations. Facilitators included: involvement and empowerment of patients, promotion of advocacy movements, inspiration of top-down initiatives, creating a culture of deprescribing, fostering a patient-centered approach, and use of assertive communication when discussing patient-centric deprescribing efforts.
While lack of access to needed medicines is an unmet need, so too is polypharmacy. Like other unmet needs, pharmacists can step up and address them. Pharmacists should be leading the charge, or at least cooperating with others carrying the mantle of evidence-based deprescribing. Pharmacy managers in all settings can help to create a culture of deprescribing, advocate for deprescribing initiatives, and participate in interdisciplinary efforts aimed to improve drug therapy outcomes.
Additional information about Ensuring Quality in Pharmacy Operations and Organizational Structure and Behavior can be found in Pharmacy Management: Essentials for All Practice Settings, 4e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 4e. If your institution does not provide access, ask your medical librarian about subscribing.
1Conklin J, Farrell B, Sulemean S. Implementing deprescribing guidelines into frontline practice: Barriers and facilitators. Res Social Adm Pharm. 2019;15(6):796-800.