Health Complexity – Deprescribing Medicines
by Tim Kilpatrick
on November 30, 2023
There are few things are more complex than managing health conditions. The healthcare system is very good at tracking the prescribing of medicines. It doesn’t track deprescribing of medicines.
Seasons change, fashions change, US presidents change, but for many patients, prescriptions never do—except to become more numerous.
Among US adults aged 40 to 79 years, about 22% reported using 5 or more prescription drugs in the previous 30 days. Within that group, people aged 60 to 79 years were more than twice as likely to have used at least 5 prescription drugs in the previous month as those aged 40 to 59 years.
Over time, a drug’s benefit may decline while its harms increase, Johns Hopkins geriatrician Cynthia Boyd, MD, MPH, told JAMA. “There are a pretty limited number of drugs for which the benefit-harm balance never changes.”
Deprescribing requires shared decision-making that considers “what patients value and what patients prioritize.”
Deprescribing lacks proven clinical guidelines and time for a patient and physician discussion. The average patient visits are twelve minutes for new patients and seven for return patients*.
* Topol, Eric, Deep Medicine, Basic Books, New York, 2019, p17
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