BC Provincial Deprescribing Webinar Series #7

12 Jun 2024 BC Provincial Deprescribing Webinar Series #7

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When challenged by complex cases involving people taking too many medications, we may ask:

  • Can I stop any of these?
  • Which should I stop first?
  • Do I need to taper this drug? If so, how?
  • What should I monitor for after stopping, and when?

Many clinicians address these clinical questions successfully, improving outcomes for patients.  Sometimes, things don’t work out as hoped.  At the Therapeutics Initiative, we want to create a platform for healthcare providers, patients, caregivers, advocates and policy makers to learn from each other about successes and challenges in deprescribing through our popular Deprescribing Webinar series initiated in February 2023.  Learning together, we hope to build confidence and knowledge about deprescribing in BC and beyond. The seventh session was held on Wednesday, June 12, 2024.

DATE: Wednesday, June 12, 2024

TIME: 12:00 – 13:00 Pacific Time [convert to your local time]

WHERE: This is a free virtual event.

CME CREDITS: MainPro+/MOC Section 1 credits: 1.0. Those who registered, attended the webinar and completed the evaluation will receive their certificate.

SLIDES: You can view/download a PDF of the slide decks by clicking on the ‘DOWNLOAD‘ button.

LEARNING OBJECTIVES

By the end of the presentation, attendees will be able to

  1. Recognize when a medication list is not appropriate for a patient’s long-term health
  2. Begin to develop a plan to simplify by deprescribing potentially harmful or redundant drugs.
  3. Identify helpful collaborators (pharmacists, specialists, or other colleagues) who can assist with successful deprescribing.

Case 1: Personalized tapering and deprescribing of an antidepressant

Presented by: Shawn Gill PharmD, RPh

Dr. Shawn Gill, founder of Deprescribe Solutions, is a community pharmacist. Dr. Shawn Gill graduated from the University of Toronto Faculty of Pharmacy in 2015. Since then he has developed a clinical practice dedicated to chronic disease prevention, alleviating medication burden, and empowering patients to embrace lifestyle interventions for successful medication reduction. He focuses on deprescribing medicines for high blood pressure, early-stage type 2 diabetes, anxiety, and depression.

Dr. Gill presented an apparently simple case of a young woman who wanted to stop taking desvenlafaxine, the active metabolite of venlafaxine. He showed how he helped this patient to approach a very gradual and orderly taper under supervision, with the support of her psychotherapist – following the approach suggested by Dr. Horowitz. If you are unaware of the difficulty some people experience in stopping antidepressants, or worked with patients to overcome that, you may find this case particularly thought-provoking.

Case 2: Where do we begin? Digging deep and taking the reins. Deprescribing in the context of medical and psychiatric complexity

Presented by: Marrison Marwood MD and Shayna Henry MD, CCFP

Recently trained family physicians showed us their approach to a patient under the care of numerous specialists who experienced multiple complex physical and mental health issues. Key issues include deprescribing in the context of diagnostic uncertainty, fragmented and incomplete health records, and multiple prescribers, and how to maintain a trusting therapeutic alliance – even while reconsidering his legacy prescriptions. Caring for this patient involved re-evaluation of drugs from many therapeutic classes – amidst concerns about his cognition, mood, and movement symptoms. Drs. Marwood and Henry, plus multiple consultants, have probably devoted > 100 hours to working with this outpatient over the last 2 years, but in this webinar they show in about 20 minutes how they approached this challenge.

Dr. Marrison Marwood is a senior resident in Family Medicine and Palliative Medicine. After a Masters degree in Medical Humanities at King’s College, London, and medical degree from the University of Buckingham, she returned home to Southern Ontario for family medicine training at McMaster University. She considers herself lucky to have a supportive husband who does not work in healthcare, a gorgeous and spirited 3 year old son, and a 3 month old baby boy, who in his free time, enjoys listening to audiobooks and deprescribing webinars.

 

Dr. Shayna Henry is Assistant Professor in the Department of Family Medicine at McMaster University. After a Masters degree in Global Health at McMaster University, she studied medicine at University College Cork in Ireland. She returned to McMaster for Family Medicine residency training, where she now works as a Family Physician. Her interests include addictions medicine and the care of equity deserving populations.

The BC Provincial Deprescribing Webinar series are coordinated by:

Tom Perry MD, FRCPC
Clinical Associate Professor, Department of AP&T, UBC
Co-Chair, Education Working Group, UBC Therapeutics Initiative
tom.perry@ubc.ca

Wade Thompson PharmD, PhDAssistant Professor, Department of AP&T, UBC
Organizer, International Deprescribing Conference
Co-Chair, Education Working Group, UBC Therapeutics Initiative
wade.thompson@ubc.ca

Over 2,500 participants signed up for at least one of the six Deprescribing Webinar sessions held to date. Links to the previous sessions (links include the slide decks and video recording for each session):

INVITATION TO SUBMIT & PRESENT A CASE AT FUTURE WEBINARS!

Please let colleagues or friends know about this new webinar series.

  • We host a 1-hour case-based webinar every 2-3 months.  The initial schedule is Wednesdays at 12:00-13:00 h Pacific Time, but we may vary this in future, depending on demand.
  • Deprescribing Webinars are open to pharmacists, doctors, nurse practitioners, nurses, health profession students, patients & care providers, and others in health care who are interested in how to address undesirable polypharmacy effectively through responsible deprescribing.
  • The Webinars are case-based.  We invite case submissions from any health profession (including students, and potentially from patients/caregivers who wish to share their experiences).  As in any health care setting, we expect our audience to respect the confidentiality of information presented with informed patient consent.

Who should submit?

  • Nursing, psych nursing, NP, medical, and pharmacy students or residents;
  • Recently qualified practitioners working in hospital, community, or long-term care who identify a deprescribing problem or success they think will interest others;
  • Senior clinicians in any health care field who want to share their acumen and experience with deprescribing clinical logic, pharmacokinetics, avoiding withdrawal, teaching others how to deprescribe successfully, use of electronic aides or AI;
  • Patients or families who think their story may enlighten health professionals.

What will you need to submit a case?

  • Patient consent to present anonymized relevant history, physical findings, drug list;
  • Consent of your supervisor if relevant (e.g. students/residents);
  • Obtain key details including all medications and doses, relevant vital signs (e.g.supine & standing BP and HR, RR and SaO2) while you have authorized access to patient record.

If interested, please contact Dr. Perry or Dr. Thompson at the emails above.  We will work with submitters to develop succinct, effective presentations that allow time for audience discussion in Zoom Chat, Q&A, and through our moderators.  If you wish to propose a case, don’t be shy! DO respect patient privacy – don’t disclose any information that could identify an individual.  Dr. Perry can discuss possible case presentations by telephone, if you email him.

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