Have your say:
Let’s make medication safety a top priority in Canadian research!
Congratulations and a big THANK YOU to everyone who completed the Canadian Institutes of Health Research (CIHR) Strategy for Patient-Oriented Research (SPOR) survey on patient-oriented research priorities. Thanks to your efforts, medication safety is in the running to become a priority in patient-oriented research in Canada!
Our work is not yet finished. Phase 2 of this public consultation has begun, and we need to act quickly. The deadline is next Friday, October 29th to vote for the theme "Pharmacological Therapies" and comment on why safe and appropriate medication use is an important aspect of this theme. Didn't participate in phase 1? That's OK! You can still take part in phase 2.
Step-by-step instructions for how to participate:
Step 1: Go to the survey web page.
Step 2: “Sign in” to your account, or “Register” for a new account.
Step 3: Click on the “IDEAS (NEW)” tab. Here, find the “Pharmacological Therapies” theme and click ❤️ to vote for it!
Step 4: Under the “Pharmacological Therapies” idea, post a comment which:
Explains why you feel “Pharmacological Therapies” is an important theme; and
Identifies the aspects of this theme you feel are important.
Step 5: Click on the “FORUM (NEW)” tab (to do so, you may have to go back to the home page). Under “Forum 1,” click “Go to discussion,” and click on the “Reply” button to leave a comment. Your comment should elaborate on the description of “Pharmacological Therapies” to help CIHR better understand what the theme encompasses.
Deadline to complete: Friday, October 29th, 2021
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.
You may wish to consider the information below for your responses:
Why we feel the theme "Pharmacological Therapies" is important
The Canadian Institutes of Health Research are asking why the theme “Pharmacological Therapies” is important to you. Here are 5 aspects of this theme we feel are important:
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 medication use
We believe that too many older Canadians experience harm from their medications. More research is needed to address this growing problem.
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?
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.
Key aspects of the theme "Pharmacological Therapies"
Under the “FORUM (NEW)” tab, the Canadian Institutes for Health Research is asking you to expand on their description of “Pharmacological Therapies.” Below are some key points about each aspect of their definition for you to consider for your responses.
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Canada spends $1.4 billion each year treating medication side effects in older Canadians. This money could be better used to provide safer drug or non-drug therapies to treat or prevent a number of health conditions. |
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Patients who may benefit from deprescribing may not be able to communicate this need due to cognitive, linguistic, cultural or physical barriers. Health professionals must be able to recognize these barriers to provide the best care possible. |
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When patients know about deprescribing, they are more likely to engage in discussions with their health providers about their medications. Health providers are given training on how and when to prescribe medications, but very little on when to stop them or on how to do so safely. |
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Patients deserve reliable and accessible information about their medications. Too many patients turn to questionable sources of information when it comes to their health, which may lead to poor decisions. |
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Approximately 1 in 10 hospital admissions among older adults are the result of a medication side effect and over half of these are considered avoidable. Many seniors will be victim of medication cascades, which happen when the side effect of one medication is treated with a new medication. Health professional training should include how to recognize medication side effects and prescribing cascades. |
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Many Canadians do not have access to the non-drug therapies whose safety and effectiveness are supported by scientific evidence, such as physiotherapy to treat chronic pain or psychotherapy to treat depression or anxiety. This increases patients' and health professionals' reliance on medications, which is not always the safest or the most effective treatment. |
Patient Stories
Further Reading
Improving Prescription Drug Safety for Canadian Seniors. Report by the Institute for Research on Public Policy by Nicole F. Bernier (2017) https://irpp.org/wp-content/uploads/2017/01/study-no61.pdf
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
About us
We, the Canadian 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.