Physicians reflecting on their use of antipsychotics and sedatives in seniors were able to deprescribe and reduce the risks associated with inappropriate medications and polypharmacy.
Calgary Hospitalists reduce their use of antipsychotics and sedatives in seniors following education and data with feedback sessions.
Choosing Wisely Recommendations
- Do not routinely use antipsychotics to treat primary insomnia in any age group
- Do not routinely continue benzodiazepines initiated during an acute care hospital admission without careful review and plan of tapering and discontinuing, ideally prior to hospital discharge
- Do not use antipsychotics as first choice to treat behavioural and psychological symptoms of dementia
- Do not use benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia
Guidelines retrieved from Choosing Wisely Canada.
Percent of patients receiving both antipsychotics and sedatives
Deprescribing involves stopping medications to decrease the risks related to polypharmacy and has been shown to be particularly important in older people (ref) whom can be at risk of adverse reactions(ref), falls (ref), and cognitive decline (ref).
In Canada, more than 50% of seniors at long-term care facilities are prescribed more than 5 medications per day (ref). In addition to the risks associated with polypharmacy, use of antipsychotics and sedatives in seniors is often not indicated as front line medications for conditions such as insomnia and dementia.
In 2014, Calgary zone hospitalists partnered with the Physician Learning Program to examine prescribing practices and determine if facilitated educational sessions could result in increased adherence to the principles of deprescribing and appropriate use of antipsychotics and sedatives in seniors.
Determine if delivery of CME sessions combined with data report delivery and facilitated feedback sessions results in reduction in the use of antipsychotics and sedatives in seniors.
The patient visits and inpatient antipsychotic and sedative medication data are retrieved from Sunrise Clinical Manager (SCM) while dispensed outpatient medication data is pulled from Pharmaceutical Information Network (PIN) administrative database for two time periods – 3 months before the patients’ admission and 3 months after discharge.
We recruited 66 hospitalist physicians across the four adult hospital sites in Calgary to receive data reports. Of these, 28 hospitalists participated in interactive sessions. Sites were able to empower themselves to suggest actions base on the data and interactive group reflection sessions.
Physician-identified change strategies
Increase awareness with other groups/educational
Continual data reporting
References, More Information, and Education Resources
Cross C. Introducing deprescribing into culture of medication. CMAJ 2013;185:E606.
Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther 2001;23:1296-310.
Frank C, Weir E. Deprescribing for older patients. CMAJ 2014; DOI:10.1503 /cmaj.131873
Hamilton HJ, Gallagher PF, O’Mahony D. Inappropriate prescrib- ing and adverse drug events in older people. BMC Geriatr 2009;9:5.
Ramage-Morin PL. Medication use among senior Canadians. Health Rep 2009;20:37-44.