What’s the news: With polypharmacy prevailing in more than 20% of U.S. adults, the AMA is calling on patients and physicians to carefully and continuously reexamine whether the individual benefits of each medication outweigh the potential risk.
One in five American adults is taking five or more prescription medications in a given month, according to a National Center for Health Statistics (NCHS) data brief. That meets the definition of polypharmacy, and it is a matter that merits greater attention from patients and doctors, says a recently published op-ed by AMA CEO and Executive Vice President John J. Whyte, MD, MPH.
“That’s why the American Medical Association is urging physicians and patients to embrace a concept gaining critical momentum in health care: deprescribing,” he wrote, explaining that the practice is “the planned, supervised process of reducing or stopping medications that may no longer be beneficial—or may be causing harm.”
As physicians well know, there are numerous reasons why a medication may no longer be the best choice for a given patient, Dr. Whyte explained in the op-ed, which was published at KevinMD.com. “A patient’s condition may have improved, and the medication is no longer needed. Or newer treatments may offer better outcomes in place of current medication. In addition, patients may have started to take a new over-the-counter drugs or supplements.”
Why it’s important: Polypharmacy “disproportionately affects older adults and those with multiple conditions,” Dr. Whyte wrote. “For these patients, each additional pill can increase the risk of falls, cognitive decline and adverse events, contributing to tens of thousands of emergency room visits and hospitalizations each year.”
Among adults 60–79 years old, more than one-third used five or more prescription drugs during the previous month, according to the NCHS data brief.
The effort to implement deprescribing should not be mistaken for counterproductive denials of care or cost-cutting that comes at the expense of patients’ health. Rather, explained Dr. Whyte, “it’s about ensuring that every medication prescribed is truly necessary, evidence-based and aligned with a patient’s current health goals.”
In his op-ed, Dr. Whyte encouraged patients to “bring all their medications and nonprescribed therapies to each appointment to ensure physicians can provide individualized assessments and clear communication about which medications continue to be best for each patient.”
But that, he wrote, is just a first step. “If we truly want to reverse the tide of chronic disease in America, we need to go beyond managing symptoms,” Dr. Whyte’s op-ed says. “We need to rethink the entire approach—including how many medications a person is on and why. Of course, many conditions require lifelong treatment. But we need to talk more honestly about the role of lifestyle as essential components of healing and prevention.”
Lifestyle, he noted, encompasses nutrition, physical activity, sleep, stress and social connection.
“Good medicine includes knowing when to say, ‘Let’s take another look,’” Dr. Whyte added.
There’s a need, he wrote, for “open conversations between doctors and patients about medication goals, side effects and overall quality of life.”
Among other things, the AMA has policy that encourages:
- Educating patients about the significant effects of all medications and most supplements.
- Physicians to teach patients to bring all medications and supplements or accurate, updated lists including current dosage to each encounter.
- Physicians and ancillary staff, if available, to initiate discussions with patients on improving their medical care through the use of only the minimal number of medications—including prescribed or over-the-counter, including vitamins and supplements—needed to optimize their health.
The AMA also is working other stakeholders and EHR vendors to:
- Address the continuing problem of inaccuracies in medication reconciliation and propagation of such inaccuracies in electronic health records.
- Include nonprescription medicines and supplements in medication lists and compatibility screens.
“Deprescribing is not about withholding care—it’s about delivering the right care, at the right time, for the right reasons,” Dr. Whyte’s op-ed says. “At its core, this is about respect: for the science, for the art of medicine, and most importantly, for the lives of our patients.”
Learn more: The AMA supports education and decision-making tools that help physicians care teams evaluate medications more holistically, Dr. Whyte noted. That includes these highly relevant AMA STEPS Forward® toolkits:
- “Medication Management: Save Time by Simplifying Your Prescribing and Refill Process.”
- “Embedding Pharmacists Into the Practice: Collaborate with Pharmacists to Improve Patient Outcomes.”
- “Team Documentation: Improve Efficiency of EHR Documentation.”
AMA STEPS Forward toolkits are part of the AMA Ed Hub™, which also offers these useful CME modules:
