by Emma Kampouraki
Earlier this week, I attended a very successful seminar in the School of Pharmacy Newcastle University. Entitled ‘Optimising medications for people with limited life expectancy’, this seminar could only be a great opportunity to find out about factors affecting our prescribing culture, not only in the UK, but in western world in general.
Basically, the main point of the speaker Dr Adam Todd, Reader in Pharmaceutical Public Health, School of Pharmacy was to showcase the current evidence on surplus medication prescribed for elderly people with late stage diseases with limited life expectancy according to predictions of clinicians. De Todd had extensive experience in lung cancer patients who have been prescribed medication ‘for life’, which at some point lose their purpose and should be discontinued. However, no clinician or pharmacist would easily review the medication list of those patients unless an adverse drug reaction or change in their clinical response appeared. In many cases, patients are under the impression that they really shouldn’t discontinue any medication, without understanding of the actual effect of the particular drug to their bodies. Therefore, even if the need to discontinue a specific therapy is pointed out to them, their lack of education doesn’t allow them to accept the proposal as a positive change, but rather return to a different prescriber with the desire to leave with a prescription for the exact same drug.
Guidelines fail to consider situations like this and they don’t provide recommendations on discontinuation of a medication if its mostly preventative nature is no longer useful for the patients and could only continue reducing their quality of life. Healthcare professionals are not aware of the consequences of unnecessary medication for the patient either. Therefore, the vicious circle continues and leaves those who understand the problem with the only option to raise awareness in scientific conferences and informal chats.
With all current information and guidance available about prescribing, is it time to look the other way and reduce the load of polypharmacy that heavily strikes the elderly population and costs millions to the NHS each year? The change is in front of us; we just have to learn and go with it.