Surveys Show Why VA Good Prescribing Practice Also Should Include Deprescribing

By Annette M. Boyle

BOSTON—For years, physicians have had one primary question about the medications they prescribe: Will the patient take them? But, now, as awareness of the dangers of polypharmacy increases, more clinicians struggle to determine the best way to discontinue prescriptions.

Amy Linksy, MD, MSc, of the VA Boston Healthcare System said VA patients sometimes complain that taking too many drugs is a burden. Photo from Twitter

“We know there are benefits of reducing polypharmacy. If you have someone stop taking a medication that is no longer beneficial to them; you reduce their risk of harms from the medication. If you reduce the number of medications someone takes, you increase their adherence,” said Amy Linsky, MD, MSc, of the VA Boston Healthcare System.

“Many veterans talk about the burden of taking so many medications and how taking multiple medications on various cycles makes them feel sicker and older,” she said.

A recent review conducted by European researchers added to the advantages of supervised medication discontinuation enumerated by Linsky. “Deprescribing may be associated with potential benefits including resolution of adverse drug reactions, improved quality of life and medication adherence and a reduction in drug costs,” according to an article in the European Journal of Internal Medicine.1

Research on deprescribing focuses on “what is the best way to stop or taper a medication and how to know when a medication’s risk exceeds it benefits for a specific patient,” Linsky explained.

Preferences for Interventions to Improve Ability to Deprescribe Medications

Linsky and her colleagues have researched the challenges of deprescribing from both the provider and patient perspective. In the abstract, everyone agrees that discontinuing medications that are outdated, not indicated, causing adverse effects or of limited benefit compared to their risk makes sense, but “there is little guidance to clinicians about how to integrate the process of deprescribing into the workflow of clinical practice,” they noted in a study of provider preferences published in BMC Health Services Research.2

Changing the habits of providers and expectations of patients can require more work than continuing to prescribe a medication that may no longer provide a benefit. A number of factors might compound the challenge, including patient complexity, clinical uncertainty and shared patient management.

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