Patients prescribed medications for longer than recommended

Almost half of patients are being prescribed common medications for longer than recommended, putting them at unnecessary risk of harmful side effects, new research shows.

The findings come from a study of 50,000 patients, led by University of Otago, Christchurch, Professor Dee Mangin, who is also a general practitioner and Professor of Family Medicine at McMaster University in Canada.

The 50,000 patients were Canadian but Professor Mangin says results are very relevant to New Zealanders.

“From guidelines to electronic prescribing systems to our measures of quality, medical systems are geared to starting medications, but not stopping them. For many drugs, use is intended to be medium term rather than a life sentence,’’ Professor Mangin says.

“When drugs are taken for longer than required the balance point tips and the risks then outweigh the benefits. Added to that is the fact that taking more drugs than necessary, often called polypharmacy, can result in dangerous interactions between medications or between medications and other conditions.”

Professor Mangin and her colleagues analysed the de-identified medical records of 50,000 people prescribed medications for depression, heartburn and acid stomach, osteoporosis and the prevention of loss of bone density. They chose these medications because they represented drugs commonly used for a range of conditions and generally recommended for use for longer than three months, but not long term. The source of the data was the MUSIC network (McMaster University Sentinel and Information Collaboration), an electronic database of primary care records in the Hamilton area of Canada.

The researchers found 43% of all patients were prescribed these medications for longer than recommended, and a substantial proportion were still taking them.

Professor Mangin says there are many reasons for what the study found.

“Most prescribing systems have no controls to flag the end of an intermediate-term prescription, while routine re-prescribing software features are usual. These results are therefore not surprising and indicate a need for system-oriented change that encompasses prescribing systems, education and patient-pharmacist-physician communication on appropriate stopping of drug therapy,’’ Professor Mangin says.

“This study identifies an enormous opportunity to improve care at a system level by looking more closely at systems for stopping medications.”

Professor Mangin says patients on multiple medications should take all their drugs to their GP for a review, at least annually, to talk about whether there are possibilities of lowering the number of medications taken.

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