Pharmaceutical Society of Australia
The Pharmaceutical Society of Australia (PSA) is the peak national professional pharmacy organisation and represents Australia’s 30,000 pharmacists working in all sectors and locations. PSA’s core functions include: providing continuing professional development, education and practice support; developing and advocating standards and guidelines; and representing pharmacists’ role as frontline health professionals.
4.
Do not prescribe medications for patients on five or more medications, or continue medications indefinitely, without a comprehensive review of their existing medications, including over-the-counter medications and dietary supplements, to determine whether any of the medications or supplements should or can be reduced or discontinued.
Do not prescribe medications for patients on five or more medications, or continue medications indefinitely, without a comprehensive review of their existing medications, including over-the-counter medications and dietary supplements, to determine whether any of the medications or supplements should or can be reduced or discontinued.
The use of medications for older people can improve symptom control and reduce disease progression. However, the use of five or more medications is independently associated with poor clinical outcomes including increased hospital admissions, falls and premature mortality. Deprescribing (which is the process of discontinuing or reducing medications) is an intervention to improve the quality use of medicines. Deprescribing is an intervention to manage polypharmacy that requires balancing the potential benefit and harm of each medication then systematically withdrawing medications that are no longer needed or clinically indicated or are inappropriate for that individual at that time. There is a growing body of evidence to support deprescribing in older people.
Supporting evidence
- Martin P, Tamblyn R, Benedetti A, et al. Effect of a pharmacist-led education intervention on inappropriate medication prescriptions in older adults: the D-PRESCRIBE randomised clinical trial. JAMA 2018; 320(18):1889-1898
- Page A, Potter K, Clifford R, et al. Deprescribing in older people. Maturitas. 2016;91:115-134. doi: 10.1016/j.maturitas.2016.06.006
- Potter K, Flicker L, Page A, et al. Deprescribing in frail older people: a randomised controlled trial. PLoS one. 2016;11(3):e0149984. doi: 10.1371/journal.pone.0149984
- Page AT, Clifford RM, Potter K, et al. The feasibility and the effect of deprescribing in older adults on mortality and health: A systematic review. Br J Clin Pharmacol. 2016;82(3):583-623. doi: 10.1111/bcp.12975
- Page AT, Clifford R, Potter K, et al. A concept analysis of deprescribing medications in older people. Journal of Pharmacy Practice and Research. 2018;48(2):132-148 doi:10.1002/jppr.1361
- Potter K, Page A, Clifford R, et al. Deprescribing: A guide for medication reviews. Journal of Pharmacy Practice and Research. 2016;46(4): 358–367 doi:10.1002/jppr.1298
- Scott IA, Anderson K, Freeman CR, et al. First do no harm: a real need to deprescribe in older patients. Med J Aust 2014;201(7):390-2.
- Reeve E, Thompson W, Farrell B. Deprescribing: A narrative review of the evidence and practical recommendations for recognizing opportunities and taking action. European Journal of Internal Medicine. 2017 Mar 1;39 (supplement): 3-11
How this list was made
A working party of members of the Pharmaceutical Society of Australia (PSA) was established. Members of the State and Territory Branch Committees were invited to contribute suggested recommendations. Over 40 recommendations were submitted. The working party grouped the recommendations into themes, eliminated ones that were out of scope, reduced the list to twelve and refined the wording. All PSA members were sent an online survey to rank the proposed recommendations, indicate how likely they would be to implement the recommendations in practice, and suggest additional items for consideration.
Based on the survey responses, six recommendations were shortlisted and supporting evidence gathered. The final list was signed off by the PSA Board in November 2018.
Note: PSA uses Vancouver reference style. Where there are more than three authors, only the first three are listed followed by et al.
Related recommendations
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1
Do not initiate medications to treat symptoms, adverse events, or side effects (unless in an emergency) without determining if an existing therapy or lack of adherence is the cause, and whether a dosage reduction, discontinuation of a medication, or another treatment is warranted.
- 2 Do not promote or provide homeopathic products as there is no reliable evidence of efficacy. Where patients choose to access homeopathic treatments, health professionals should discuss the lack of benefit with patients.
- 3 Do not dispense a repeat prescription for an antibiotic without first clarifying clinical appropriateness.
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4
Do not prescribe medications for patients on five or more medications, or continue medications indefinitely, without a comprehensive review of their existing medications, including over-the-counter medications and dietary supplements, to determine whether any of the medications or supplements should or can be reduced or discontinued.
- 5 Do not continue benzodiazepines, other sedative hypnotics or antipsychotics in older adults for insomnia, agitation or delirium for more than three months without review.
- 6 Do not recommend complementary medicines or therapies unless there is credible evidence of efficacy and the benefit of use outweighs the risk.