MedsAware: Deprescribing Action Week

MedsAware is SHPA’s Deprescribing Action Week, 18-24 March 2024, raising awareness around polypharmacy and deprescribing.

This year, MedsAware will focus on the theme:

'Ask because you care.'

Medicines can have important benefits in curing and preventing diseases and improving symptoms. However, the potential benefits and harms of medicines can change over time as a person ages, acquires new medical conditions, takes new medicines and changes their care goals. Therefore, medicines should be regularly reviewed to make sure that they are still of benefit, and not causing any harms.  

‘Polypharmacy’ refers to the use of multiple medicines, usually defined as the use of five or more regular medicines. 

‘Deprescribing’ describes the process of discontinuing medicines that are no longer required, or for which the risk of harm outweighs the benefits in the individual. 

Medicines should never be stopped without talking to a doctor or pharmacist.

  • MedsAware 2024, Deprescribing Action Week is about driving conversations around discontinuing medicines that are no longer required, or for which the risk of harm outweighs the benefits. 

  • MedsAware seeks to raise awareness around ‘polypharmacy’ and ‘deprescribing’, empowering Australians and their care teams to manage every medicines regimen ensuring it is current, effective and safe. 

  • This year’s theme is about empowering older Australians, Australians living with a disability, and their carers, to ask health professionals: “Could any of these medicines be doing more harm than good?” Ask because you care. 


MedsAware webinar

This webinar will focus on consumer engagement and communication about medication-related harm and the importance of deprescribing.

Wednesday 20 March 2024

Presented by Dr Justin Turner, Senior Lecturer, Centre for Medicine Use and Safety, Monash University, Melbourne, Vic, and Tara Quirke, Registered Nurse; Aged Care and Dementia Consultant; Advocate and Carer, Brisbane, Qld

Register today!


 

What is polypharmacy?

  • Polypharmacy refers to the use of multiple medicines, usually defined as the use of five or more regular medicines. 

  • Australian research indicates nine in 10 Australians in aged care take at least five regular medicines every day, and 65% take more than 10 ('hyperpolypharmacy'). 

  • Polypharmacy and hyperpolypharmacy are associated with increased risk of side effects and other medicine related harms like falls and hospitalisation

  • 250,000 Australians are admitted to hospital each year due to medication-related issues, many of which are preventable; we need to break this cycle.1

What is deprescribing?

  • Deprescribing describes the process of discontinuing medicines that are no longer required, or for which the risk of harm outweighs the benefits.

  • Think of deprescribing as spring cleaning for your medicine cabinet. Just like how you tidy up your house and get rid of objects that are causing clutter without being useful, deprescribing tidies up your medication list to keep only the ones that are truly required. 

  • Deprescribing is safe when planned and supervised by a healthcare professional. 

  • Deprescribing minimises the risk of withdrawal effects through careful monitoring and gradual tapering of medicines. 

  • Deprescribing empowers the care team and the patient through safer, shared decision-making.

What are psychotropic medicines?

  • Psychotropic medicines are drugs that can affect the mind, emotions or behaviour. The three main classes of psychotropic medicines are: 

    • Antidepressants: used mostly to treat depression and other mental health conditions 

    • Anxiolytic/Hypnotics: used to manage anxiety and insomnia (sleep problems)  

    • Antipsychotics: used to treat severe mental health conditions, and may be used to treat challenging behaviours in people living with dementia and people living with intellectual disability.2

  • Psychotropic medicines, when prescribed to control challenging behaviour of people living with dementia and people living with a disability, should only be used short-term, with informed consumer and/or carer consent. 

  • When not used appropriately, psychotropics medicines do not have a benefit and can cause harm which diminishes the wellbeing and quality of life of older people and people with disability.
     

Inappropriate use of psychotropic medicines

  • Inappropriate medicines refers to medicines that are no longer required, or for which the risk of harm outweighs the benefits in the individual.  

  • Challenging behaviours are too often addressed by starting psychotropic medicines for patients without first attempting to use evidence-based non-pharmacological interventions.  

  • Evidence shows that psychotropic medicines are being overused to control challenging behaviours in older people and people with disability. 

  • Older Australians, Australians living with a disability, who are taking psychotropic medicines should regularly discuss with their carers and health care teams the need for these medicines when used to control challenging behaviour and consider deprescribing where appropriate.  

  • In an Australian study of adults with intellectual disability, 35% of patients were prescribed psychotropic medicines without a psychiatric diagnosis.3

  • In an Australian study of adolescents with intellectual disability, 82% were inappropriately prescribed psychotropic medicines.4

  • The Royal Commission into Aged Care Quality and Safety reported that 61% of Australians in residential aged care were regularly taking psychotropic medicines.5

  • It has been estimated only 10% of the antipsychotic medications and benzodiazepines used in residential aged care is clearly clinically justified. 

  • In a recent study of older patients admitted to an emergency department, polypharmacy was observed in 80.5% of patients. 9.5% of these admissions were attributed to one or more potentially inappropriate medicines, the most common of which were benzodiazepines, accounting for 73.6% of these admissions.6


From the President:

Deprescribing is in the DNA of SHPA, Australia’s pharmacy organisation for team-based, specialty pharmacist care.

‘The world’s first published use of “deprescribing” was in our flagship Journal of Pharmacy Practice and Research (JPPR) 20 years ago, in ‘Deprescribing: Achieving Better Health Outcomes for Older People through Reducing Medications’.

‘As medicines experts, pharmacists are best placed to detect and prevent inappropriate use of high-risk medicines, including antipsychotics, that are widespread in residential aged care facilities.

'MedsAware Week 2024 seeks to empower Australians and their carers, family and friends, together with pharmacists, doctors and other care team members, to optimise every medicines regimen to ensure it is current, effective and safe.

‘We’re proud to lead the MedsAware message and work with our partners to embed deprescribing as a central principle of safe health care, to reduce polypharmacy and hyperpolypharmacy and ensure more Australians stay out of hospital.’

— SHPA President Tom Simpson


 

Our partners

Australian Deprescribing Network

The Australian Deprescribing Network (ADeN) involves clinicians, academic researchers, policy makers, students and consumers working together to develop the evidence-base, clinical guidance and knowledge translation to facilitate deprescribing of medicines that are no longer providing benefit or are causing harm. ADeN aims to promote research, awareness, practice and policy for the safe and appropriate use of medicines for all Australians.

Visit their website to:

  • Learn more about deprescribing
  • Find resources to support deprescribing in practice including guidelines, communication tools and resources for the public
  • Learn about their upcoming events
  • Sign up to their email list to hear about upcoming opportunities, news, events and more!

Follow us on X (formerly Twitter) @DeprescribeAU

Resources and publications

For consumers

For Health Professionals 

Key publications

Clinical Resources

References:
1. https://www.psa.org.au/advocacy/working-for-our-profession/medicine-safety/take-care/
2. https://www.agedcarequality.gov.au/resource-library/psychotropic-medications-used-australia-information-aged-care#:~:text=What%20are%20psychotropic%20medications%3F&text=The%20three%20main%20classes%20of,classes%20include%20anticonvulsants%20and%20stimulants.
3. Song, M.; Ware, R.; Doan, T. N.; Harley, D. (2019). Psychotropic medication use in adults with intellectual disability in Queensland, Australia, from 1999 to 2015: a cohort study. Journal of Intellectual Disability Research, (), jir.12685–. doi:10.1111/jir.12685 
4. Song M, Ware RS, Doan TN, et al. Appropriateness of psychotropic medication use in a cohort of adolescents with intellectual disability in Queensland, Australia. BJPsych Open 2020;6(6):e142. At: www.ncbi.nlm.nih.gov/pmc/articles/ PMC7745239/pdf/S2056472420001258a.pdf
5. Exhibit 3-61, Sydney Hearing, Statement of Juanita Westbury, 29 April 2019, WIT.0117.0001.0001 at 0008 [13]; J Westbury et al. ‘More action needed: Psychotropic prescribing in Australian RACFs’, Australian and New Zealand Journal of Psychiatry, 2019, Vol 53, 2, p 139 (Exhibit 3-2, Sydney Hearing, general tender bundle, tab 49, RCD.9999.0032.0128).
6. Tran HTM, Roman C, Yip G, Dooley M, Salahudeen MS, Mitra B. Influence of Potentially Inappropriate Medication Use on Older Australians' Admission to Emergency Department Short Stay. Geriatrics (Basel). 2024 Jan 4;9(1):6. doi: 10.3390/geriatrics9010006. PMID: 38247981; PMCID: PMC10801464.