If you are taking a large number of prescription drugs you might want to ask your doctor whether you should throw out some of them. Taken together they might be causing you more harm than good.
A new study conducted by researchers from RCSI University of Medicine and Health Sciences in Dublin, Ireland, found that particularly older adults often take a number of medications that might interact with one another. They might therefore be healthier without them.Read More »
Challenges to medical system
This situation creates challenges for the overall healthcare system, the researchers explain. Not only does it involve high costs for the people who take the medication, it also is a strain on the people themselves as well as their carers in having to cope with having to take so many drugs. An added stress is on the medical providers who have to decide what medications need to be taken.
The result is that a third of all older Americans take prescription drugs that are not appropriate for the symptoms or could cause even more harm to them, according to the university research team.
Determining a solution
The study included 51 general practitioners and 404 patients each taking at least 15 prescription drugs. Half of the patients continued to take their medications (the control group) while the other half (the intervention group) submitted the drugs they were taking to review by medical professionals and acted on their recommendations.
Included in the review were:
• A screening of each drug prescription in order to determine which were inadvisable to be taken together;
• A look into what opportunities existed for stopping some of the medications;
• An investigation into which drugs the patients were able to stop taking; and
• Which of the drugs should be a priority for the treatment of the patients.
Once they had gathered this information, the research team examined whether the review resulted in reducing the number of medications that the patients were taking and whether it also resulted in an improvement in the quality of the prescriptions they were taking.
As a result of the study the doctors were able to cut more than 800 drugs among the 208 patients in the intervention group—an average of eight medications for each patient. In the cases of those who were taking 15 medications, it amounted to half of all the drugs they were taking.
The next step was to test the impact of the action taken on the intervention group. After removing the more than 800 medications from them, the researchers found that only 15 patients suffered possible side-effects as a result of ending those prescriptions. Almost all of the side-effects were little more than a mild reaction from the treatment being stopped. The symptoms disappeared once the doctors put the patients back on that specific drug.
In assessing the quality of the prescribing of the medications, the researchers used a checklist of those medications that could result in harm being done to the patient when combined with other drugs. The list of the unwise combinations were provided to the control group as well as the intervention group. The result was an overall improvement in both groups in this regard during the period of the study.
Identifying drugs likely helped
It is likely that the act of identifying the medications to the entire group of at-risk patients might in itself have led to improvements in the prescribing of the medication, explains Dr. Caroline McCarthy, a research fellow and clinical lecturer at the Department of General Practice at RCSI University.
McCarthy points out, too, that most general practitioners whose time and resources are limited do not have the means to check out the drugs that their patients are taking, particularly if the drugs build up in number over time. In addition, patients might be wary about changing their medications, she adds.
In conclusion, Professor Susan Smith, associate director of the HRB Primary Care Clinical Trials Network, said the intervention approach to handling this challenging problem shows that even in a complex group of people stopping medications that might no longer be appropriate or needed is not only possible but also safe.
The study appears in PLOS Medicine.
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