‘Deprescribing’ – A Clinician’s Perspective

Blog Posts  |  16 July 2019  |  By Tom Pasquariello, PharmD, BCPS, BCMAS, PMSP

What are Deprescribing and Polypharmacy?
“Deprescribing’ has been described as “the planned and supervised identification and reduction or discontinuation of unnecessary, inappropriate or ineffective medications. It is a collaborative process that involves weighing the benefits and harms of medications in the context of a patient’s care goals, current level of functioning, life expectancy, values, and preferences”1. Often, deprescribing is the result of communication between prescriber and pharmacist that leads to additional review of the patient’s care plan. Deprescribing should often be considered for patients who have polypharmacy issues (defined as the use of multiple drugs or more than are medically necessary, a growing concern for older adults2) that are experiencing adverse drug reactions, affected by disease state guideline changes, or are suffering from multiple diseases that treatment has been unsuccessful.

Why Does Deprescribing Matter?
Deprescribing has established a strong use case as a potential resolution to polypharmacy. A recent study found that nearly 40% of older Americans take five or more prescription medications.3 Of those, nearly 50% take one or more medications that are not medically necessary.2 Doctors and pharmacists can play a vital part in managing both these types of events by knowing what resources are available to them and educating themselves on how to utilize them properly. In addition to being aware of proper ways to discontinue specific medications, providers may find it helpful to break down and simplify the process of evaluating a patient’s extensive medication list. For example, using a two-step approach to help simplify the process, or evaluating one medication at a time for deprescribing.

How Can Veradigm Technology Help?
Veradigm is committed to improving the effectiveness of electronic health records, electronic prescribing and other clinical workflow tools in ways that drive meaningful improvement for patients while simplifying workflow for clinicians. Two key features of Veradigm ePrescribe that can help the patient, physician, and pharmacist are CancelRx and RxChange. Both features were enabled within as part of the National Council for Prescription Drug Programs (NCPDP) SCRIPT 10.6 Standard, mandated by the Centers for Medicare and Medicaid Services (CMS) starting in 2010. CancelRx is a message from the physician office to the pharmacy that can alert a pharmacist to discontinue therapy and cancel any pending medication refills that the patient should no longer receive. RxChange is an inbound message from the pharmacy to the physician office that can recommend a generic/therapeutic substitution or a substitution for a medication that requires prior authorization. Approximately half of all pharmacies in the U.S. are presently enabled to send and receive these messages.

Assisting Pharmacists in Meeting the Challenge
A common frustration amongst pharmacists is feeling that they are being called upon to understand the physician’s intent with incomplete information. I know I find myself asking, “Hmm, I wonder what the physician is thinking about this medication regimen, is this meant to be in addition to or instead of the current regimen?”. CancelRx can help clarify when current medications should be discontinued and replaced with newly written medications by removing the guesswork and follow-up with physician. This should help to decrease unnecessary medical errors, as well as save practices and pharmacists time that could be better spent with patients.

Many pharmacists are reluctant when it comes to recommending medication changes to a provider. While RxChange provides the capability to do so, for the technology to reach its full potential, pharmacists may need additional support to help them to overcome this reticence. For example, pharmacists often feel they are not equipped with enough information to make an educated recommendation for medication regimen change, while community pharmacists are expected to cover so much ground they may lack time to stay current on every research guideline on proper medication management.

Future of Deprescribing
Some EHR and pharmacy systems still lack transparency to patients’ past medical history, labs, consultations, etc. However, the larger issue remains the technology and patient-specific data – or lack thereof – available to help enhance communication between prescribers and pharmacists without unduly complicating or weakening providers’ current preferred workflow. Current and upcoming advancements in technology through interoperability and artificial intelligence should help pharmacists in the future make more confident choices, as with the Rx Change feature. Veradigm will continue to partner with healthcare technology providers from across the industry to deliver the comprehensive, user-friendly tools clinicians need to provide the highest level of care to patients in today’s rapidly evolving healthcare environment.

1 http://exclusive.multibriefs.com/content/pharmacists-role-in-promoting-patient-safety-through-deprescribing/pharmaceutical

2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3864987/

3 https://medshadow.org/deprescribing-benefits/