DEPRESCRIBING AND TODAY’S PHARMACY REALITY…AN OXYMORON

Deprescribing refers to the reduction in dose and/or stopping of medication that may be causing harm, may no longer be providing benefit, or may be considered inappropriate. The process of deprescribing should be planned and supervised by health care professionals. The goal of deprescribing is to reduce medication burden and harm, while maintaining or improving quality of life.

Scientist Barb Farrell with the Bruyère Research Institute in Ottawa is an executive member of the Canadian Deprescribing Network, a new national group of health professionals, researchers and patients formed to help the elderly reduce the number of prescription drugs they’re taking.

In a recent article in the Ottawa Citizen written by columnist Don Butler, Butler quotes Farrell:

“We’ve got a four-year plan with a goal of reducing unnecessary or inappropriate medication use in older patients by 50 per cent by 2020.  It’s a lofty goal, but we thought we might as well shoot high.”

I further reference Don Butler below:

The rates of medication use by seniors are “shockingly high,” Farrell says. In 2012, nearly two-thirds of seniors submitted claims for five or more drug classes and 27 per cent had 10 or more, according to the Canadian Institute for Health Information (CIHI).

The simultaneous use of multiple medications, known as polypharmacy, is a growing concern around the world, driven by aging populations and the availability of more and more prescription drugs.

Not only does over-prescription put seniors at risk from side effects and potentially diminish their quality of life, it also drives up costs for governments, which foot much of the drug bill for seniors.

The aim is to develop deprescribing guidelines for the drugs and educate primary care physicians on how to have effective conversations with patients about discontinuing or tapering off medications.

The deprescribing guidelines are the first ever developed. “There are many, many prescribing guidelines that tell you when to start a drug,” Farrell says, “but none of them address when it might be appropriate to stop the drug.”

Interestingly Farrell goes on to say:

“For doctors, one challenge will be to find time to do medication reviews with their patients.”

Not sure where Farrell gets her information that doctors do “medication reviews”.  And if she that doctors any time soon are going to start doing such reviews for which there is no listed compensation to doctors, then she is really out of touch with main stream medical economics.

Too bad Farrell is unaware that the Ontario Government has given the task of doing medication reviews to pharmacists for whom there is, at least in principle, some compensation, skill and motivation to do med reviews.   The quality of these med reviews is another question, which will soon come to haunt the profession of pharmacy.

The really big question however is this one.

If deprescribing ultimately results in less prescriptions being filled (kinda the opposite of medication adherence), and pharmacists are still largely compensated for filling prescriptions, how is this going to work in real life?

Recognize that deprescribing is a cognitive activity requiring pharmacological knowledge and a high level of education and understanding of the interaction among drugs and different disease conditions and all simultaneously.

It will be interesting especially to see how Big Pharmacy Retail (BPR) will respond to this initiative.  The notion of BPR’s employee pharmacists, whom BPR compensates, being compensated to reduce the number of billing units (prescriptions) so that revenues will be reduced in direct proportion to the number of reduced prescriptions.

This sounds like a recipe for retail suicide.

Will there be quotas for the number of prescriptions pharmacists can eliminate?  Will ‘district managers’ soon monitor the number of prescriptions individual pharmacists have cancelled?  The sun will rise in the west before this happens.

It may be good healthcare delivery.  It may be great economics for payers, especially government.  But it’s a recipe for disaster for business.

Hence once again we are confronted by the direct contradiction between pharmacy as a profession (which is practiced by pharmacists), and the business of pharmacy which is overwhelmingly controlled by non-pharmacist corporations, or BPR.

Once again, employee pharmacists are being set up to lose no matter what they do.  And once again we ask, “Where are the regulatory bodies and associations?”  It isn’t even on their radar screen.

 

 

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