Johanna Trimble on tackling over-medication as a CADeN public partner

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The theme of World Patient Safety Day 2023 is engaging patients for patient safety. In celebration of the amazing contributions of our patient and public partners, we asked a few of them two questions about their experience engaging with our network.

Johanna Trimble (pictured above) is a founding member of the Canadian Medication Appropriateness and Deprescribing Network (CADeN), and a past co-chair and current member of our Public Awareness Committee. Read her responses below!

Why is it important for you to contribute as a public partner with CADeN, and what are the most rewarding aspects you've experienced so far? 

When I began advocacy work on over-medication over 12 years ago, nobody quite knew what I was talking about. I would say—“many older people are on too many drugs and it can seriously harm them! I know because it’s happened in my family more than once.” But often friends with older parents did understand. I would hear this repeatedly: “they keep giving my Mom more drugs but she just gets worse not better.”  These families were seeing the consequences of over-medication but had no solutions or were afraid to bring it up to medical staff. I began to see this problem as a public health issue on the scale of the harms of smoking. I still do. I felt we would need to make this a national priority to begin to make a change. As with smoking, the evidence of the harms of over-medication and the need for change is becoming more and more clear.

CADeN has been working towards this change since it started and I’ve been involved as a public partner from the beginning. Working with like-minded doctors, pharmacists and public partners has legitimized and reinforced what I saw happening in my own family. I had hoped, but had difficulty imagining, that this issue would be taken up at a national level. CADeN is doing that. An emphasis on effectiveness, safety and education is of equal importance to access to pharmaceuticals for any National Pharmacare strategy. I saw the consequences of over-medication in my own family and experienced the difficulty of addressing it alone. Tackling this issue will have the best chance of success if we can work together: politicians, citizens and medical professionals.

How has your involvement with CADeN as a public partner impacted you and your community? 

CADeN has reinforced and legitimized my personal experience with over-medication issues. It’s no longer just my own opinion and experience that I bring to my community work but the backing of the doctors and pharmacists that I work with in CADeN. We’re working towards the same goal of patient health and safety. We’ve been able to write information in plain, not medical, language for public handouts on pharmaceuticals. I am confident using them as they have been checked for accuracy by our CADeN pharmacist. I can use these freely at community events, meetings and workshops for both the public and for medical professionals. Personally, I now have a feeling of camaraderie with professionals that I value highly. Some of our public informational handouts have been taken up internationally and it has been tremendously gratifying that our work is known and used beyond Canada.

Community champion in the spotlight: Herb John convinced we can make a difference

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National Pensioners’ Federation Past President and longstanding CaDeN member on why deprescribing speaks to Canadian seniors, and what needs doing next.

By Jennie Herbin, Community Engagement Coordinator, Canadian Deprescribing Network (CaDeN)

This interview has been edited and condensed.

Herb John was waiting to board a plane to Ottawa for a Canadian Transportation Agency meeting when I caught him on the phone this weekend. He’d only just returned from Regina, where he’d attended the 2018 National Pensioners’ Federation (NPF) Convention, and was now off again. This type of schedule is not unusual for the busy volunteers I am lucky to work with.

Quickly, our conversation turned to civic engagement, and how he’d met two young people in Regina who were surprised to learn that the NPF is fighting so that younger generations would have a pension. “They’d just assumed they [younger generations] wouldn’t be able to count on having a pension. People need to believe they can make a difference. Imagine if 50 people called their local MP about an issue. They’d start listening.”

Among the many hats he wears, Herb John is a member of the Canadian Deprescribing Network’s (CaDeN) Public Awareness Committee and a committed deprescribing advocate. His initiatives to raise deprescribing awareness over the years reflect this conviction that everyone has a role to play, and that together we can make change happen.

You’ve been working with CaDeN to get the word out about deprescribing for a few years now. Why did you first get involved?

I got an email from Cara Tannenbaum [CaDeN Co-Director] a few years ago, asking if I would participate in a panel discussion at one of CaDeN’s early meetings. I’d never heard of deprescribing at that point. But I immediately thought of a situation I’d had with my grandmother a few years earlier. I had to bring her to emergency, and I had to go gather up her medications and bring them to the hospital too. I couldn’t believe all the medications she was on. The emergency doctors cut half of them out. I thought, if I’m having this problem, I’m probably not the only one. There must be a lot of other people who are having this happen to them too.

So when Cara emailed me, I immediately understood what deprescribing was and recognized the relevance. Even then, I called her back and said, are you sure I’m the one you want? Cara responded saying that what they needed to do was get the word out to seniors, and she’d been told that a seniors’ advocacy group would be the best way to do that. Well then, I got it. That’s how I could help. I was on board, and our executive board endorsed the campaign.

What shape has your collaboration taken over the years?

Pretty soon, we were in communications about how to get the word out. We [NPF] started posting material about deprescribing on our website. Every month, we post CaDeN’s newsletter on the site. We [NPF] invited Cara Tannenbaum to give a presentation to our members at our 2016 annual convention in Richmond, B.C. Now, several of our affiliate organizations are involved with CaDeN as well.

What kind of response do you get when you talk to people about deprescribing?

This spring I gave two presentations to retired automobile union member groups in Windsor, Ontario. One of them was my own retired workers chapter. I’d approached the chair and asked if I could do a presentation. He said sure, but make sure you keep it brief because the members don’t want a long presentation. Well I spoke for 30 minutes! And no one was nodding off, everyone was paying attention. I got lots of compliments about the relevance and importance and timeliness of the topic. People seemed to appreciate the information—they “got” it.  

After the presentation, I told everyone that at the next meeting in September, I’d be asking how many went to their pharmacist or doctor and asked those five key questions. Which I did. Well, 10% of people said they did have that conversation.

Why do you think this topic speaks to people so much?

Most people haven’t heard about the concepts before. But it makes sense. I still run into lots of people who don’t question what their doctor tells or gives them. They have no idea about those three major deprescribing messages: first, that some people are taking too many medications; two, that some mixtures aren’t good; and third, that medications affect us differently when we age. It’s a major awareness issue people need to understand.

What do you feel are the next steps?

Pauline Worsfold, Chair of the Canadian Health Coalition (CHC), gave a presentation on the Pharmacare file at the NPF convention last week. The CHC and NPF have been pushing hard for a Pharmacare program. People are starting to become aware that across the provinces, there’s a real mishmash of coverage. In New Zealand, when they implemented Pharmacare a few years ago, they saved $7 billion in the first year alone. But I haven’t heard anyone talk about deprescribing as part of the Pharmacare discussions. It should be part of a national Pharmacare program. The public would quickly understand the added benefit of ensuring the medications we’re taking are helping rather than harming.

We need to take advantage of this opportunity to talk about deprescribing, in the context of Pharmacare. We need people to start talking in their own jurisdictions about including deprescribing in the national Pharmacare conversation. If implemented properly, it could be a huge cost savings.