New medicines advice: Prescribing cascades, polypharmacy, homeopathy
New recommendations on the prescribing of multiple medicines and the effectiveness of complementary medicines, including homeopathy, have been released today by Choosing Wisely Australia.
The Pharmaceutical Society of Australia (PSA) developed its inaugural Choosing Wisely list of six recommendations for Australians to consider around medicines use – this includes prescription, over-the-counter and complementary medicines.
NPS MedicineWise Client Relations Manager, Dr Robyn Lindner, said: “Sometimes people are unsure of what medicines they’re taking and why. We encourage you to discuss the implications of each new medicine with your healthcare provider and ensure you are fully informed about issues such as necessity, risks and side effects.
“These new recommendations will help guide health professionals and their patients in a discussion about appropriate use of medicines based on the latest evidence,” Dr Lindner said.
Each year, approximately 230,000 Australians are admitted to hospital as a result of medication misadventure.* This is almost four times the annual number of people who are hospitalised as a result of motor vehicle accidents. It also costs the Australian health system $1.2 billion each year, yet 23% of adverse drug events in primary care are preventable.
PSA National President Dr Chris Freeman said “While the use of medicines offers significant benefits for many people, they may also cause unnecessary harm. It is important that we balance the positive and negative effects of each medicine, tailored to each individual with their care goals front of mind.
“As experts in medicines, pharmacists have the ability to provide specialised review of a person’s medication regimen, resulting in recommendations or actions to help people get the most out of their medicines. Any person taking multiple medicines, high-risk medicines, or who is at high risk of medicine misadventure, including transitioning between care settings, should have their medicines reviewed,” Dr Freeman said.
“In regards to homeopathic products there is no reliable evidence of efficacy. All health professionals should take the time to discuss with health consumers, who are taking or considering taking these products, the lack of efficacy and the risks in rejecting or delaying other treatments known to be safe and effective.
“Prescribing data shows that close to 25% of repeat antibiotic prescriptions were dispensed more than four weeks after the initial dispensing, indicating potentially inappropriate antibiotic use in the community. Pharmacists can help to reduce the burden of antibiotic resistance by first clarifying the clinical appropriateness of repeat antibiotic prescriptions before dispensing.”
Dr Freeman said many health consumers turned to complementary and alternative medicines for a variety of reasons and often sought expert advice from pharmacists relating to these products.
“Pharmacists and medical practitioners should present clear information to consumers about the safety of and evidence for complementary and alternative medicines and only recommend these products when the known benefit outweighs the potential harm,” he said.
The six PSA recommendations are:
- Do not initiate medications to treat symptoms, adverse events, or side effects (unless in an emergency) without determining if an existing therapy or lack of adherence is the cause, and whether a dosage reduction, discontinuation of a medication, or another treatment is warranted.
- Do not promote or provide homeopathic products as there is no reliable evidence of efficacy. Where patients choose to access homeopathic treatments, health professionals should discuss the lack of benefit with patients.
- Do not dispense a repeat prescription for an antibiotic without first clarifying clinical appropriateness.
- Do not prescribe medications for patients on five or more medications, or continue medications indefinitely, without a comprehensive review of their existing medications, including over-the-counter medications and dietary supplements, to determine whether any of the medications or supplements should or can be reduced or discontinued.
- Do not continue benzodiazepines, other sedative hypnotics or antipsychotics in older adults for insomnia, agitation or delirium for more than three months without review.
- Do not recommend complementary medicines or therapies unless there is credible evidence of efficacy and the benefit of use outweighs the risk.
Choosing Wisely Australia encourages people to ask questions around any test, treatment or procedure being recommended to them and offers a list of 5 Questions people can ask their doctors or other healthcare providers.
There have been 189 healthcare recommendations released through Choosing Wisely Australia by 42 colleges, societies and associations since the initiative launched in April 2015.
*Australian Commission on Safety and Quality in Health Care. Literature Review: Medication Safety in Australia. Sydney: ACSQHC, 2013.
- Choosing Wisely Australia: Lyndell Coutts, Communications Lead – 02 8217 8650 / 0429 050 103
- PSA: Jarryd Luke, Senior Communications Officer – 0487 922 176
About Choosing Wisely
Choosing Wisely Australia® is enabling clinicians, consumers and healthcare stakeholders to start important conversations about tests, treatments and procedures where evidence shows they provide no benefit and, in some cases, lead to harm. The campaign is led by Australia’s medical colleges and societies and facilitated by NPS MedicineWise.
About NPS MedicineWise
Independent, evidence-based and not-for-profit, NPS MedicineWise enables better decisions about medicines, medical tests and other health technologies. We receive funding from the Australian Government Department of Health.
About the Pharmaceutical Society of Australia
PSA is the only Australian Government-recognised peak national professional pharmacy organisation representing all of Australia’s 31,000 pharmacists working in all sectors and across all locations.PSA is committed to improving Australia’s health through excellence in pharmacist care. PSA believes the expertise of pharmacists can be better utilised to address the health care needs of all Australians.
PSA works to identify, unlock and advance opportunities for pharmacists to realise their full potential, to be appropriately recognised and fairly remunerated. PSA has a strong and engaged membership base that provides high-quality health care and are the custodians for safe and effective medicine use for the Australian community.
PSA leads and supports innovative and evidence-based healthcare service delivery by pharmacists. PSA provides high-quality practitioner development and practice support to pharmacists and is the custodian of the professional practice standards and guidelines to ensure quality and integrity in the practice of pharmacy.