Reducing prescribing cascades

Reducing prescribing cascades

On September 14, 2022 the University of British Columbia’s Therapeutics Initiative, an academic service that provides unbiased evidence about drug therapy to prescribers and pharmacists, released its latest Therapeutics Letter (issue 138) on “Reducing prescribing cascades”. The authors hope to stimulate prescribing doctors, nurse practitioners, and pharmacists to consider the possibility that adverse effects caused by some prescriptions beget more prescriptions that are not necessary. This sequence was first dubbed a “prescribing cascade” by Canadian and US geriatricians over 25 years ago.

Says Dr. Aaron Tejani, a research and drug utilization pharmacist with the TI:

We hope our Letter will encourage more doctors, nurse practitioners and pharmacists to consider prescribing cascades when they do careful medication reviews for patients. We know many people are taking more prescription or non-prescription drugs and supplements than they really require. Because of this, some are losing quality of life or putting their health in long-term jeopardy.

Although our reports are aimed primarily at health professionals, they may also be helpful to the public. If you wonder whether you, or a relative or friend, could be experiencing a prescribing cascade, you can also visit the public web page of the Canadian Deprescribing Network.

Dr. Lisa McCarthy, professor at the University of Toronto Leslie Dan Faculty of Pharmacy, has studied how prescribing cascades arise in practice and recently presented her findings to the first International Conference on Deprescribing in Denmark. Says Dr. McCarthy:

Prescribing cascades can cause important harm. Once we start to look for them, they are everywhere. To tackle them, we need a movement to change attitudes. When a new sign, symptom or medical condition arises, clinicians and the public need to ask: “Can this be caused by a medication?” This should become an initial investigative step for anyone taking medications.

We invite you to read this latest issue of the Therapeutics Letter and submit a comment if you wish to contribute to this conversation. We will consider posting brief comments if accompanied by name and affiliation and a completed ICMJE conflict of interest declaration.

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