Medications are effective and potent treatment options for protecting and advancing human health – but, if taken incorrectly, can also cause harm, especially in older people who take multiple medications over long periods of time. periods.
That’s why experts from the Leslie Dan School of Pharmacy at the University of Toronto and Women’s College Hospital have led an effort to create a new tool for prescribers to identify, prevent and manage potentially harmful prescribing practices. inappropriate, called “prescription cascades”.
“Prescription cascades occur when one drug is prescribed to manage the side effects of another drug – often when a side effect is misinterpreted as a new medical condition,” explains Lisa McCarthydeprescribing expert and associate professor at the Leslie Dan College of Pharmacy.
“Sometimes it makes sense to introduce a new drug to treat the side effects of another, but sometimes the prescriber doesn’t recognize that what they’re seeing is, in fact, a drug-induced effect, and that can lead to inappropriate and potentially harmful prescription effects.
Inappropriate drug use following prescribing cascades can put people at unnecessary risk of adverse drug events, reduced quality of life, and additional costs to individuals and healthcare systems. Health care.
To solve the problem, McCarthy and his collaborators created a tool called ThinkCascadeswhich identifies nine clinically important prescribing cascades that affect older adults when treating common conditions such as anxiety, insomnia, hypertension, or urinary incontinence.
The tool was recently introduced in an article published in the journal Drugs and aging.
“By identifying nine clinically important prescribing cascades, this tool helps clinicians recognize other prescribing cascades when managing polypharmacy,” says Paula RochonSenior Scientist at the Women’s College Research Institute, Professor in the Department of Medicine at Temerty Medical School and the Institute for Health Policy, Management and Evaluation at the Dalla Lana School of Public Health, and Founding Director of the Women’s Age Lab based at Women’s University Hospital in Toronto.
“If we adjust our thinking to draw attention to awareness of prescribing cascades when reviewing drugs, then we can work towards optimizing therapies and reducing drug harms for older adults, by especially women.”
While the research team notes that there are many examples of prescribing cascades in healthcare globally, the nine included in the tool were selected by engaging a multidisciplinary panel of over 30 clinicians. from six countries with expertise in geriatric pharmacotherapy.
“Many clinicians struggle to identify prescribing cascades both conceptually and in clinical practice, making them underrecognized contributors to drug-related harm,” says McCarthy, who is also a clinician-scientist at Trillium. Health Partners. “In many ways, it’s really a problem that no one sees. And when multiple prescribers are involved, responsibility for appropriate prescribing and patient education may also be unclear.
But McCarthy notes that there is growing awareness of the extent of preventable drug-related harm, with the World Health Organization (WHO) having identified drug safety as the theme for its World Drug Safety Day. patients, which took place on September 17. In addition to raising global awareness of the heavy burden of drug-related harm, WHO’s World Patient Safety Day aims to empower patients and families to actively participate in the safe use of medicines.
McCarthy says such involvement is an important aspect of harm reduction.
“We’ve seen that it’s not really on healthcare professionals’ radars to commonly think about medication-induced signs and symptoms, and so it becomes even more important for patients and families to understand their medications and be prepared to ask, ‘Do I have a problem with my medication?
“As healthcare professionals, we need to be more aware of and open to these discussions.”