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An Ecological Approach to Reducing Potentially Inappropriate Medication Use: Canadian Deprescribing Network

  • Cara Tannenbaum (a1), Barbara Farrell (a2), James Shaw (a3), Steve Morgan (a4), Johanna Trimble (a5), Janet C. Currie (a6), Justin Turner (a7), Paula Rochon (a8) and James Silvius (a9)...
Abstract
ABSTRACT

Polypharmacy is growing in Canada, along with adverse drug events and drug-related costs. Part of the solution may be deprescribing, the planned and supervised process of dose reduction or stopping of medications that may be causing harm or are no longer providing benefit. Deprescribing can be a complex process, involving the intersection of patients, health care providers, and organizational and policy factors serving as enablers or barriers. This article describes the justification, theoretical foundation, and process for developing a Canadian Deprescribing Network (CaDeN), a network of individuals, organizations, and decision-makers committed to promoting the appropriate use of medications and non-pharmacological approaches to care, especially among older people in Canada. CaDeN will deploy multiple levels of action across multiple stakeholder groups simultaneously in an ecological approach to health system change. CaDeN proposes a unique model that might be applied both in national settings and for different transformational challenges in health care.

RÉSUMÉ

La polypharmacie est en croissance au Canada, ainsi que les effets indésirables des médicaments et les coûts associés à la drogue. Une partie de la solution peut être la déprescription—le processus planifié et contrôlé de la réduction des doses ou la cessation des médicaments qui peuvent nutrient ou qui n’offrent plus d’avantage. La déprescription peut être un processus complexe impliquant des patients, les professionnels de la santé et des facteurs de politique et d’organisation qui peuvent servir comme facilitateurs ou obstacles. Cet article décrit la justification, le fondement théorique et le processus de développement d’un Réseau canadien de dépréscription (ReCaD), un réseau d’individus, d’organisations et de décideurs engagés à promouvoir l’utilisation appropriée des médicaments et des approches non pharmacologiques aux soins parmi les personnes âgées au Canada. ReCaD déploiera plusieurs niveaux d’action à travers des groupes de parties prenantes multiples simultanément dans une approche écologique à l’évolution du système de santé. ReCaD propose un modèle unique qui pourrait être appliqué à la fois dans les contextes nationaux et aux différents défis de transformation dans les soins de santé.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
La correspondance et les demandes de tirés-à-part doivent être adressées à : / Correspondence and requests for offprints should be sent to: James Shaw, Ph.D. Institute for Health System Solutions and Virtual Care – Women’s College Hospital 76 Grenville Street Toronto, ON M5S 1B2 (jay.shaw@wchospital.ca)
Footnotes
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* We acknowledge and thank the Canadian Institute for health Information for their support with the data analysis presented in this article.
Janet C. Currie’s name was misspelled as Jane Currie in the printed and original online versions of this article. An erratum has been published.
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Canadian Journal on Aging / La Revue canadienne du vieillissement
  • ISSN: 0714-9808
  • EISSN: 1710-1107
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