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MEETING HIGHLIGHTS

The Canadian Deprescribing Network is very grateful to all those who participated in the 2018 National Stakeholder Summit on Medication Safety for Older Men and Women, which took place on February 9th, 2018, in Montreal. See photos of the summit here.

Executive Summary

To achieve a truly sustainable solution to medication harms, everyone needs to be at the table. The Summit on Medication Safety brought together health care providers, patient advocates, policy makers and community organizations from every province in Canada. The goal was to gather key provincial players and enhance local capacity to ensure safe prescribing and deprescribing. The Summit was also an opportunity to share innovative strategies and varied perspectives to help reduce medication harms among seniors.

At the Summit, we heard from diverse speakers from every province in Canada. They discussed cutting-edge initiatives, promising practices and successful policies in their province. Local community and seniors’ organizations discussed how they were engaging their communities to reduce the rising epidemic of opioid and sedative-hypnotic medication use among Canadian seniors.

Summit objectives

1. Share successful strategies from different provinces and territories for reducing the use of opioids and sedative-hypnotics among older men and women.

2. Provide a networking opportunity and forum for dialogue among diverse stakeholders including seniors’ advocates, health care providers and policy makers.

3. Learn how to leverage the activities of the Canadian Deprescribing Network in your area

The ultimate goals for the Canadian Deprescribing Network was to learn how different stakeholders could help us:

• Reduce harm by decreasing the use of risky medications like opioids and sleeping pills in seniors by 50% by 2020
• Promote health by increasing the access to safer drug and non-drug alternatives

To achieve these goals, the Canadian Deprescribing network asked the following questions at the Summit:

• What are best ways of communicating to seniors, caregivers and their families?
• How do we reach healthcare providers so they can help reduce medication harms and advise patients?
• How do we ensure that medication appropriateness is on the health policy agenda?

Total Summit attendance: 107 partipants

Summit highlights

Champions at the local level

Since its launch, the Canadian Deprescribing Network has been raising public awareness, educating physicians, pharmacists and nurses through outreach and talks. The Network has also been working with provincial pharmacy directors to reexamine access rules for risky medications and partnering with many different pan-Canadian organizations to get the message out.

But this is not enough. We realized that in order to achieve our goals and truly help older men and women, we need champions at the local level to help reach the corners of each and every province. Deprescribing takes not only health care providers, but change at the policy level and most importantly, through empowered patients themselves.

Success Stories from around the country

The Summit featured success stories from around the country from tackling the opioid crisis through patient education in Manitoba to deprescribing sedative-hypnotics through coordinated efforts in a family health team in Ontario. Sleepwell Nova Scotia discussed how they are helping people get off of sleeping pills by learning how to manage insomnia with cognitive behavioural therapy, a much safer and effective alternative. Representatives from senior’s organizations provided many useful insights as to how to reach their members.

The Deprescribing Fair

The Summit was an opportunity for the Canadian Deprescribing Network to showcase its Deprescribing Fair. The Fair is an interactive exhibit hosted by clinicians, researchers, policy makers and other stakeholders with expertise in deprescribing. Interactive booths, displays and games help increase awareness and skills to support appropriate prescribing. The Fair also offers tools for both patients and seniors’ organizations to help safely optimize medication use and consider deprescribing and alternative therapies.

Many researchers from the Centre de recherche de l’Institut universitaire de gériatrie de Montréal animated the various booths and games. A dozen guest exhibitors joined the Fair, including the Canadian Agency for Drugs and Technologies in Health, the Canadian Foundation for Healthcare Improvement, the Canadian Institutes of Health Research, Choosing Wisely Canada, Deprescribing.org and the Fédération québécoise des Sociétés Alzheimer.

Crowdsourcing Bold Ideas for Maximum Impact

Dr. Andrea Murphy and Dr. David Gardner from Dalhousie University moderated a very successful and informative crowdsourcing activity. They asked meeting participants the following question: What is your biggest, boldest idea to minimize the use of sedative-hypnotics and opioids? The activity got participants thinking outside the box.

Here are the top 5 bold ideas:

First place idea

• Policy to restrict driving license use if a prescription is filled for an opioid or sleeping pill (like in Denmark).

Second place idea

• Prescribers must document their rationale for prescribing medications in the e-health record, note the date of reassessment and possible deprescribing.
• Target prescribers for intervention who have high rates of prescribing for a quality improvement intervention.
• Develop a national awareness campaign where patients have the possibility to share their experience with sedative / opioid drugs and how they succeed to reduce their use.
• Mandatory annual review of medication by a health provider (in person).

Third place idea

• Coverage for non-pharmacological therapies prescribed by a healthcare provider: massage, physiotherapy, etc. 

Fourth place idea

• Develop a peer education network using community organizations. Train a deprescribing ‘champion’ in each group. The champion would discuss and disseminate materials.
• Train members of public in cognitive behavioural therapy for insomnia (older adults teaching older adults).
•  Measure, track and report sleeping pill and opioid prescription trends of teams or doctors.
•  Increase access to alternative treatments through:
  • The development of alternative treatments
  • Increasing public transportation for seniors
  • Increasing education to the public about what options are available
  • Increasing research on effective age-specific treatments

Fifth place idea

• For sedative-hypnotics: provide mental health literacy for everyone, starting in schools, at university and in public health campaigns across all age groups. We need to understand what is ‘normal’ and what isn’t.  Is it wrong to sleep less as we age? No, it’s normal! Are difficult feelings like sadness, grief, worry and anger a diagnosis? No, mostly these are not diagnoses that need medication but we need to fundamentally shift from a culture of illness that leads to excess diagnoses and prescriptions.
• Have private and public insurance plans cover alternative pain management therapies the same way medications are covered.

Networking lunch for representatives from seniors’ organizations

The Canadian Deprescribing Network also held a network lunch with all the community and seniors’ organizations that took part in the Summit.

They were asked to write down their ideas to address the following question: What is the most effective approach to engage seniors in deprescribing?

Keynote speaker

The Summit's keynote speaker was Dr. Jennifer Zelmer, President of Azimuth Health Group who presented her talk, Think Global, Act Local & Use Levers for Change in Between. She discussed different approaches and perspectives to influence large-scale change. Dr. Zelmer also spoke about spreading, sustaining and scaling-up activities to foster change in the health care system. She had all Summit participants commit to one action "by next Thursday" to support medication safety. The Canadian Deprescribing Network team is following up with all participants about their actions.

Follow-up

The Canadian Deprescribing Network will be following up with all participants from the Summit. We will seek opportunities for collaboration to raise awareness about medication safety among seniors, health care providers and policymakers. We will also be speaking with organizations who may help publish our articles, share our tools and disseminate our brochures. The Summit was the start to fruitful collaborations!

Keep in touch!

Our contact information:

Canadian Deprescribing Network
Centre de recherche de l’Institut universitaire de gériatrie de Montréal
4565 Queen-Mary Road, Montreal (Quebec) H3W 1W5
Email: info@deprescribingnetwork.ca