Looking to Tackle Prescription Overload

The initiative calls for a 25 percent reduction in medication use within a year, with AMDA monitoring the results. “An ambitious goal,” said Dr. Sabine von Preyss-Friedman, co-chair of the Drive to Deprescribe work group. “But if you do a little here and a little there, you don’t move the needle.”

To date, 2,000 facilities have enrolled, along with three major consulting pharmacies that serve them. That represents a fraction of the nation’s 15,000 nursing homes, with several large chains unrepresented, but “we are still recruiting,” Dr. von Preyss-Friedman said.

Another milestone in the polypharmacy battle: the U.S. Deprescribing Research Network, established in 2019 and funded by the National Institute on Aging. So far, it has awarded nine grants to test effective deprescribing strategies.

“Stopping a medication is not just the reverse of starting one,” said Dr. Michael Steinman, a geriatrician at the University of California, San Francisco, and co-director of the network. “It’s often much harder.”

The barriers reflect a fragmented health care system, in which a patient’s endocrinologist, for example, pays scant attention to what her cardiologist or neurologist has prescribed, while her primary care doctor hesitates to overrule any of them.

Deprescribing discussions also require time, a luxury during a brief office visit with a senior who may have many competing needs.

“There’s a general bias toward doing things in medicine,” said Dr. Ariel Green, a geriatrician and researcher at Johns Hopkins. “If we prescribe something, that’s seen as a positive action. If we stop something, or don’t start it, that’s not.”


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