MedSafer triples success in reducing inappropriate medications, study shows

A software developed by MUHC researchers could become a new standard of care to address overprescribing in Canada.
 

Source : MUHC, McGill University

Deprescribing – the practice of stopping, reducing or substituting potentially inappropriate medications – is recognized as a promising way reduce medication-related harm and lower unnecessary healthcare costs. However, safely and effectively implementing this approach in healthcare remains a challenge.

A new clinical trial conducted in in long-term care facilities and published in the journal JAMA Network Open suggests that medication reviews for older adults should include a deprescribing process. The study also shows that using the electronic decision-support tool MedSafer could make the process more effective. MedSafer was co-developed and is being licensed by Dr. Emily McDonald and Dr. Todd Lee, who are both physicians at the McGill University Health Centre (MUHC), researchers at the Research Institute of the MUHC (The Institute) and Associate Professors in the Department of Medicine at McGill University.

“Nearly two thirds of Canadian seniors take five or more medications a day, and the number is significantly higher in long-term care,” says Dr. McDonald, lead author of the study.  “Sometimes we blame aging for memory loss or mobility issues when the real culprit is the medications. I’ve seen patients go from barely responsive to having conversations again after stopping a sedating medication.”

When clinicians review a patient’s file, MedSafer flags potentially inappropriate medications —drugs whose harms may outweigh their benefits, may be ineffective, or for which safer alternatives exist. In this new clinical trial, the software was implemented in five long-term care homes in New Brunswick during an intervention phase that followed a control phase using standard medication reviews. With MedSafer, 36 per cent of participants had at least one potentially inappropriate medication deprescribed—nearly three times the rate seen without the tool (12.7%). The trial included 725 residents, each taking an average of 10 medications, including at least one potentially inappropriate medication.

Fitting MedSafer into routine care

Medications in long-term care homes are typically reviewed every three months, but there’s no standard approach to deprescribing. Acting as a checklist for clinicians, MedSafer scans the medication list alongside the resident’s health conditions, flags drugs that may no longer be appropriate and provides guidance on how to stop some medications or suggests safer alternatives.

Avoiding ‘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,” says Dr. Lee. “The more you take, the more side effects and interactions you can have.”

The researchers aim to have 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,” adds Dr. McDonald. “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.

Drs. McDonald and Lee are co-founders of MedSafer Corp., which licenses the software used in the study.