HAVE YOUR SAY:

LET’S MAKE MEDICATION SAFETY A PRIORITY IN CANADIAN RESEARCH!

Let’s make medication safety a top priority in Canadian research!

Now is the time to have your say on the importance of medication safety in Canadian research. The Canadian Institutes of Health Research (CIHR), one of the main organizations that funds research in Canada, recently launched the survey “Online discussion: Future areas of focus for patient-oriented research.” They are asking all Canadians to share their thoughts on what research areas to focus on and fund over the next five years. This survey is an opportunity to make your voice heard on why patient-oriented research on safe and appropriate medication use should be a top priority.

Please share this webpage far and wide with your friends, family, colleagues, communities, and organizations. Together, we can bring safe and appropriate medication use the attention and funding it needs.

Complete survey now

Deadline to complete: Friday, September 17th, 2021

You may wish to consider the information below for your responses:

About us

We, the Canadian Medication Appropriateness and Deprescribing Network, have been working since 2016 to advance research and provide patients and professionals with the tools to engage in helpful conversations about medications to ensure they provide more benefit than harm. We are sharing this survey to encourage interested Canadians to have their say on Canadian research priorities. We believe there is a desperate need for more patient-focused research to make medication use safer for older adults in Canada. Keep reading to learn more about why we believe this is important to share with the Canadian Institutes for Health Research!

Who are CIHR and SPOR?

The Canadian Institutes for Health Research (CIHR) is responsible for funding research on targeted priority areas in health research in Canada. Building research, training future health researchers, and making sure new knowledge is used in practice are integral parts of CIHR’s mandate. CIHR’s Strategy for Patient-Oriented Research (SPOR) funds health research that involves patients, health care providers and decision makers to ensure research findings improve the work health care providers do. The ultimate goal is to inform the development of health policies, improve the health care system and improve the lives of Canadians.

Top 5 priority areas for research for the next five years

The Canadian Institutes for Health Research are asking for your five top priorities. Here are our top 5 priorities for you to consider:

1. Safe and appropriate use of medication

2. Deprescribing

3. Access to safe alternatives to risky medications

4. Older adults from across the country with different life experiences need to be involved in research about safe and appropriate medication use

5. Health and policy systems to support appropriate medication use

1. Safe and appropriate use of medication

We believe that safe and appropriate use of medications for older adults should be the top priority for research in the next five years.

Why is this important?

In Canada, two-thirds of older adults take 5 or more prescription medications, while one quarter takes at least 10[i]. The more medications you take, the more chance there is of drug-interactions or side effects occurring. Using too many medications is called ‘polypharmacy’ or ‘prescription overload’.
Polypharmacy can cause harm including increasing a patient’s risk of falls, cognitive impairment, hospitalization and death.
Adults age 65 and over are hospitalized 5 times more often due to harms caused by medications than those under 65[ii]. Approximately 1 in 10 hospital admissions among older adults are the result of a medication side effect[iii].
1 in 4 older Canadians take 10 or more medications. There has been little research on how all of these medications interact when taken together.
Treating avoidable harms from medications is expensive. Approximately $1.4 billion in taxpayer dollars is spent every year treating health problems in older adults caused by the use of risky medications[iv]. We need more patient-oriented research to consider the cost to individuals, including side effects, reduced quality of life and risk of hospitalization and death.

2. Deprescribing

To use medication safely, we need to know how to safely start and stop medications. Deprescribing is when patients, caregivers and health providers work together to regularly review the patients’ medications, with a view to reducing or stopping those that are risky or may be unnecessary.

Why is this important?

Billions of dollars are spent each year on medications: to research and review and bring them to market; to train doctors and other health professionals to prescribe them; for patients to purchase them; and for the system to address the consequences of their side effects. And yet, very little research has been done on how to safely stop medications.

Research studies have shown that patient-led conversations about deprescribing medications lead to deprescribing more often. More research and support are needed to scale up interventions shown to be most successful at engaging patients to reduce the use of risky medications.
Many people do not feel comfortable asking their doctor about their medications. We need patient-oriented research to figure out the best ways of sharing our existing knowledge about how to empower patients to have these conversations, and make that the standard of care. Empowering patients to start these conversations can lead to deprescribing. We believe it is necessary for all older adults to know which questions to ask about their medications, such as about the risks, and whether they still need all of them. We need patient-oriented research .

3. Access to safe alternatives to risky medications

Research shows that some medications are safer than others, some have a higher risk of side effects, and sometimes, the best treatment is not a medication at all. We believe identifying how to move this knowledge into practice should be a priority area for patient-oriented research. For example, Cognitive Behavioural Therapy for Insomnia (CBTi) has been shown to be more effective than sleeping pills for helping people sleep. However, more than 1 in 10 Canadian seniors use sleeping pills regularly. We need research to find out how to share this knowledge with older adults.

Why is this important?

More research is needed to assess the effectiveness of safe, non-medication alternatives to risky medications. Unfortunately, often there is significantly less funding for this area of research compared to research investments for new pharmaceuticals.
Health care dollars used for risky medications would be better spent on safer, evidence-based, non-drug interventions. For example, there is research evidence to support using: physiotherapy for chronic pain; psychotherapy or cognitive behavioural therapy for insomnia and anxiety; music therapy, behavioural therapy or art therapy to address behavioural difficulties in people with dementia; and increased access to exercise and nutrition programs to help prevent disease and improve health.

4. Older adults from across the country with different life experiences need to be involved in research about safe and appropriate medication use

Too often, rather than involving the older adults who take the medications, research is targeted at the health care providers who prescribe them. More efforts need to be invested to ensure that research initiatives are patient-oriented and meet the needs of older adults from different geographical and cultural communities across the country.

Why is this important?

“Nothing about us, without us” is a concept that can be traced back to the 1500s. Yet when it comes to medication use, research continues to focus on the health care providers rather than on the patients.
Research has shown that sending written information on the risks and benefits of particular medications to the older adults who are taking them empowered people to talk to their doctor and stop unnecessary or risky medications. More research is needed to move this knowledge into action and improve safe and appropriate medication use for all older adults living in Canada.
Older adults’ experiences and thoughts need to lead research initiatives. For example, in British Columbia, the Coyote’s Food Medicines story emerged from conversation and engagement with Secwepemc Elders on their community’s use of medicines. This resource aims to raise awareness among Elders around the issue of polypharmacy and was distributed widely across the province.

5. Health and policy systems to support appropriate medication use

It is essential that Canada have systems and processes in place to ensure the medications we take to manage disease and keep us healthy do not cause harm.

Why is this important?

The Canadian Deprescribing Network has been spreading the word to federal, provincial and territorial governments about the importance of appropriate medication use. We have also researched the systems and processes around the world that are in place to ensure medications are used appropriately, and have shared our findings with decision-makers. More research is needed to bring the patient’s voice forward in an exploration of these systems and processes and how they can be best used to benefit older adults in Canada.
With the creation of the Canadian Drug Agency and discussions continuing around Pharmacare, there is a window of opportunity for seniors to shape the future directions of medication affordability, accessibility and appropriateness. It is imperative that older adults be involved in the creation and implementation of the Canadian Drug Agency and Pharmacare, as well as any systems and processes put in place to support the safe and appropriate use of medications in Canada.

How to strengthen patient-oriented research in Canada over the next five years

The Canadian Institutes of Health Research are asking what else we can do to strengthen research involving patients over the next five years. Here are our priorities relating to safe and appropriate medication use for you to consider:

“Nothing about me without me”: It is vitally important that older adults taking medications who will be affected by the outcomes of the research be intimately involved in every stage of the research process, from helping to define the research question to designing and running the research initiative.
Older adults, patients and caregivers with different life experiences should be contributing partners alongside the researchers, and other stakeholders involved in medication safety and appropriateness research. This may include health professionals (doctors, nurses, pharmacists), long-term care and assisted living operators, seniors’ organization leaders, specialists on aging and social policy, policy makers, public health professionals and non-profit organizations.
Equity and equality. A diversity of patient and researcher voices and perspectives in health research need to be a priority moving forward, and this is equally true of research in medication safety and appropriateness.

Ideas for finding and engaging partners in patient-oriented research

The Canadian Institutes of Health Research are asking what guidance you could give them on how to find and engage partners in research involving patients in Canada. Here are our ideas for you to consider relating to safe and appropriate medication use:

Create research partnerships with patients, health care professional organizations and universities to ensure collaboration on research that provides meaningful outcomes to all involved.
Collaborate with community organizations: Many older adults living in the community are involved in seniors’ organizations as members or volunteers. When equipped with adequate resources, these organizations can help set, drive and execute the research agenda in the community. To our knowledge, there have been no previous initiatives engaging community seniors in research around medication appropriateness.
Social media: In future, using targeted social media campaigns may be a way to find older adults and other stakeholders interested in participating in health research.
Create a national research participation bank:
- Partner with provincial health authorities to include the option to “Sign up to the national health research participation bank” on the health card registration or renewal form.
- Partner with pharmacy chains, grocery chains, Canada Post, or provincial/municipal library networks to put posters up promoting the search for research partners. These are all places older Canadians go.
- Put posters up in doctors’ offices and hospitals.
- Providing training to ensure partners are able to fully participate and contribute to the research process.

Additional thoughts on patient-oriented research priorities

The Canadian Institutes of Health Research are asking what else you would like to share related to priorities in research involving patients. Here are our ideas relating to safe and appropriate medication use for you to consider:

Share your stories about medication safety: Have you, or do you know someone (a family member, friend, colleague or patient) who has experienced harmful side effects from medications? These stories are all too common in Canada. This would be a good time to share why you personally care about medication safety for older adults.
Big picture vision for safe and appropriate medication use: A mechanism to support research on deprescribing and medication safety for older adults should be built into the Canadian Drug Agency as well as a potential national Pharmacare program.
Post-COVID pandemic health care: Finding funding and support for research about reducing the use of treatments and procedures which carry little benefit has always been challenging. Yet, looking ahead to post-pandemic health care in Canada, reducing low-value care becomes more critical than ever.

Patient Stories:

References

i. Canadian Institutes for Health Information. (2018). Drug Use Among Seniors, 2016. CIHI. https://www.cihi.ca/sites/default/files/document/drug-use-among-seniors-2016-en-web.pdf

ii. Canadian Institutes for Health Information. (2013). Adverse Drug Reaction–Related Hospitalizations Among Seniors, 2006 to 2011. CIHI. https://publications.gc.ca/collections/collection_2013/icis-cihi/H117-5-25-2013-eng.pdf

iii. Parameswaran Nair, N., Chalmers, L., Connolly, M., et al. (2016). Prediction of Hospitalization due to Adverse Drug Reactions in Elderly Community-Dwelling Patients (The PADR-EC Score). PLoS One, 11(10): e0165757. https://doi.org/10.1371/journal.pone.0165757

iv. Morgan, S., Hunt, J., Rioux, J. et al. (2016). Frequency and cost of potentially inappropriate prescribing for older adults: a cross-sectional study. CMAJ Open, 4(2), E346-E351. https://doi.org/10.9778/cmajo.20150131