How pharmacists can be deprescribing heroes

By Judith Garber | March 2, 2021

“I am convinced when a single drug is prescribed, the doctor probably knows what to anticipate. When two drugs are prescribed, uncertainty prevails. When three drugs are prescribed, a doctor hasn’t the foggiest notion how a patient will react. When four drugs are prescribed, God doesn’t know what might ensue.”
Dr. Bernard Lown, 2012

Anyone who cares for older adults knows that medication overload has become an epidemic. Over the last decade, older people sought medical treatment more than 35 million times for adverse drug events, and there were more than 2 million hospital admissions. These adverse drug events are often a result of overprescribing– more than 40% of older adults take five or more prescription medications a day, and 20% take more than ten.

The solution to medication overload is deprescribing — taking patients off, or reducing the dose of, medications that are unnecessary or harmful. Sounds simple, but deprescribing is rare because often clinicians don’t have the time, skills, or information they need to do a full Prescription Checkup (a visit in which the patient and clinician review all the medications the patient is taking and discuss which drugs can be safely deprescribed).

Can pharmacists be the key that unlocks the full power of deprescribing? They have specialized knowledge of drug interactions and risks, and know how to safely remove and taper drugs. Yet there are many barriers in the way — most significantly, Medicare and most other payers don’t recognize pharmacists as clinical care providers and don’t pay them for this work. In short, most pharmacists are only paid to dispense medications, not deprescribe them.

How can we remove the barriers and make pharmacists our deprescribing heroes? In their recent piece in Senior Care Pharmacist, Lown health policy fellow Judith Garber and professor at the University of Washington School of Pharmacy Don Downing create a roadmap for collaboration. The article is a summary of their lecture at the American Society of Consultant Pharmacists annual meeting from November 2020. Garber and Downing outline how changes in policy, perceptions, and partnerships can make pharmacists leaders for deprescribing, and help mitigate our epidemic of overprescribing.

The American Society of Consultant Pharmacists has made this piece free for non-members to download for 30 days! Download the article on their website.

To eliminate medication overload, serious cultural, educational, and policy changes are needed. This action plan offers recommendations for policymakers, health care institutions, clinicians, and patients across five key categories to reduce harm from multiple medication use. Suggested Citation: Eliminating medication overload: A national action plan. Working Group on Medication Overload. Brookline, MA: The Lown Institute, 2020. DOI: https://doi.org/10.46241/LI.YLBW4885

Pharmaceutical marketing is a significant factor in the growing public health crisis of medication overload, which puts millions of older adults at risk of preventable harm and premature death. This issue brief provides recommendations to reduce pharmaceutical industry influence by limiting pharma sales rep visits to clinicians and direct-to-consumer advertising.

This issue brief provides recommendations for clinical practice guidelines and electronic health records that would give clinicians the information they need to appropriately prescribe and deprescribe.