Deprescribing — An Important Part of Healthcare
Betty Chaffee, PharmD, is owner and sole proprietor of BetterMyMeds, a Medication Management service devoted to helping people get the maximum benefit from their medications.
If you've been a reader of this blog you've probably seen the phrase "getting the best value out of your medications." That means not only making sure your medications are doing their job, but also taking a hard look at medications you might not need anymore. I'm a firm believer in using only medications that actually improve health. And a medication that was important for you a decade ago may not always be the medication you need now.
Deprescribing means stopping medicines that may be harmful or may simply no longer be needed. Deprescribing is important for everyone who takes medicine, but it becomes more significant as we age. That's partly because as we get older medication lists tend to get longer. And as the number of medications grows it can be frustrating and expensive to keep taking them. But it's also partly because our bodies handle medicine differently as we age. We may be more likely to suffer side effects and drug interactions. And some medications that are important in middle age may not be helpful any more as we get older.
Who's in charge of deprescribing?
First, I want to stress that you shouldn't make decisions about stopping a prescription medicine without talking to the healthcare provider who prescribed it. Hopefully, whatever your health concerns, you and your provider have discussed the plan of care so you're headed in the same direction. And if changes to that plan are being considered, either by you or your provider, you both need to be on the same page. So any time you want to consider stopping a prescription medication, talk to your prescriber about it.
But it's also true that doctors tend to be more likely to start new medicines than stop old ones. Deprescribing may not be at the top of their priority list when they see you. Generally speaking, if you want to make sure you medicines are all necessary, you'll need to start that discussion yourself. That can be tough if you're not in the habit of asking pointed questions of your healthcare provider.
So what should you do?
First of all, remember that it's YOUR health, so it's your prerogative to have frank discussions with your doctor about your health goals. That includes managing your medication list.
But also remember that medication management is what pharmacists are best at. Pharmacists, like those at BetterMyMeds, can help you decide which of your medications to discuss with your doctor first, and what questions to ask about them. If you're not sure what all of your medicines are being used for, or if you're at risk of side effects, your pharmacist can help you there, too. Use the expertise of your pharmacist to help you communicate more effectively with your doctor - it'll makes the process much smoother for you!
What about deprescribing non-prescription medicines and supplements?
When it comes to non-prescription medicines, you get to make the decisions. There may be some nonprescription medications or supplements your doctor recommended (think aspirin, vitamin D). If so, talk with your doctor about them first. But if you started taking something on your own, you can choose to stop taking it on your own.
Here again, though, input from your pharmacist can help. Have clinical studies shown it to provide health benefits? Is there risk of side effects or drug interactions? What questions should you ask yourself about whether the product is improving your health?
The benefits of deprescribing are numerous
What if you, your pharmacist, and your provider look at every medication and decide nothing should be omitted? Does that mean the process was without value? Absolutely not! Now you've had a frank and (hopefully) helpful conversation with your doctor about your health-related goals. You know what your medications are expected to do, and that each one is doing its job, at least for now. And in six months, or next year, or in two years, you'll be more comfortable bringing up the question again. And by including your pharmacist, you've learned that expert medication help is as close as a phone call.
We welcome your questions and comments below, or contact us directly at BetterMyMeds for help with your medication questions!
Great post. One thing that bothers me is that you mention to talk to your doctor before changing meds. Yes, it sounds good, but will a doctor consult with a pharmacist before making a recommendation? I don’t think a doctor is the best person to ask. A pharmacist should be first. Unfortunately, this is not how the medical profession and insurance companies work. Peoples insurances change and that sometimes means having to find new doctors. No one doctor knows our medical history anymore. Plus, some of us are not good record keepers of our health, especially when we are younger. I’ve seen several doctors and each have there own patient portals. I cannot keep track of everything.
Tony, a very insightful comment, as always!
Because pharmacists typically don’t have access to health records, the doctor is usually in a better position to know if medication is accomplishing its goal. But I agree, a pharmacist is the best FIRST step. We can identify meds that might no longer be needed, meds that might be causing problems, and good points of discussion to bring up with your doctor.
In my own practice, I go through med lists carefully and point out exactly those things. But because I don’t have access to a full medical history or plan of care, it wouldn’t be prudent for me to suggest stopping a medication. The best SECOND step is for me or the patient to talk with the prescriber and, as a team, decide the best course of action.