Framework developed for "unprescribing" drugs

Deciding which medications are no longer necessary might require prioritization when the list of what's being taken is lengthy.

By Susan J. Landers, AMNews staff. April 24, 2006.

Washington -- Physicians always can turn to research papers, guidelines and pharmaceutical companies for help in determining who should be prescribed a drug, but they often are on their own when deciding whether it's time to call a halt.

Four University of Chicago physicians decided to address this gap and have developed a framework to help with the decision-making, particularly for elderly patients, about when a medication is no longer necessary.

They propose adding factors such as life expectancy, goals of care, treatment targets and the time until a benefit is expected to the usual equation of risks versus benefits. Their work appears in the March 27 Archives of Internal Medicine.

Prescribing for elderly patients long has been a cause for concern. Because they often are being treated for several chronic diseases, such patients might be at risk for deleterious drug-drug interactions. But ignoring a treatable condition is not an option.

Treatment guidelines might add to the conundrum. As physicians move into the era of evidence-based medicine, these directives might be dictating which drug should be prescribed for which patients regardless of whether that individual might be better served by not taking it.

"Our framework was designed to help patients and physicians decide when to stop taking even safe and effective drugs in situations that are often radically different from those that existed when the medications were started," said Holly Holmes, MD, instructor of medicine at the University of Chicago and the study's lead author. "We wanted to provide a road map that would steer people away from the prescribing cascade that is common for patients late in life and guide them past the barriers that prevent removal of treatments that may no longer be effective."