The Centre for Training and Development, Aducate, at the University of Eastern Finland recently introduced a new training module that seeks to offer new guidelines for controlled deprescribing. The module is intended for pharmacy specialists in particular, and it can be completed as separate training or as part of professional development training in medication review.
Medication review is a multi-professional operating model where a specially qualified chemist or pharmacist reviews the patient’s medication regime and its problems, and makes a suggestion to the patient’s physician on how to optimise medication.
“When necessary, this should include a concrete deprescribing plan,” Coordinator Ville Valkonen, MSc Pharmacy, says.
“Qualified chemists and pharmacists can take an active role in supporting physicians during the deprescribing process. This is already being done elsewhere in the world, and there is a need to do this also in Finland,” Jonna-Carita Kanninen, MSc Pharmacy, says.
Polypharmacy is common especially among older people, as they are prescribed medications by multiple doctors. Medications can be prescribed not only to treat medical conditions, but also to combat side effects caused by other medications. On top of this, the patient may be using over-the-counter medications. The more medications the patient uses, the more likely it is for cumulative effects and side effects to occur, including tiredness, confusion and dizziness, which can predispose to falls. Older people, in particular, are susceptible to adverse effects, as the response to and elimination of medications from the body change with age.
Deprescribing can also become topical when the goals of treatment change, or when the patient is approaching the end of his or her life.
“For instance, is it necessary for someone who is confined to a hospital bed to use regular heart medication to prevent chest pain that occurs in physical strain? No medication should be continued without the need for it,” Valkonen points out.
“Medications that are potentially unnecessary get identified well, but deprescribing on a practical level remains challenging. Clear guidelines on when to initiate medication are often available, but there are no general guidelines for deprescribing individual medications,” Kanninen notes.