Reducing the risks of too much medication

A pharmacist who wants people to take fewer medications might seem like an odd idea but, for Dr Ben Basger, it's all about patient safety.

The clinical pharmacist at Sydney's Wolper Jewish Hospital recently released a study which showed many older Australians were taking too many medications.

"The more medications you're on, the more likely there is to be a problem," Dr Basger said.

"Firstly, medicine management is not simple.People assume that because someone has the legal ability to prescribe medicine, they know what they're doing.

"But what does society expect from general practitioners (GPs)? They want effective communicators, who are knowledgeable, and can perform physical exams, diagnose problems, issue tests, and interpret test results, as well as manage medication.

"The expectations are enormous and no one human being can do all that.

"Secondly, there are lots of different doctors involved in treatment, particularly once a patient is in hospital, and they all want to do their own stuff.

"When patients come into a hospital, they are managed on the acute condition they're there for – not any chronic conditions.

"If medication they're on is causing complications, it is changed or ceased; but if not, it's not dealt with at all."

The study noted up to 30 percent of hospital admissions for patients over 75 years of age in Australia were medicine-related, with up to three-quarters potentially preventable. The single-most important predictor was the number of medicines taken.

As many as 44 percent of patients did not follow medicine changes initiated in hospital, continuing to take discontinued medicines, failing to implement dosage changes, or taking newly-prescribed medicines which may themselves be potentially inappropriate.

Dr Basger said once a patient had been admitted to hospital, the number of medications they were on tended to increase, rather than decrease, and stay that way.

"If the medications are working or not doing anything, they don't get reviewed," he said.

"The patient arrives on potentially inappropriate medication, and they leave on one or two more potentially inappropriate medications."

Concerned that patients' specialists and GPs were not reading reports sent to them by hospital pharmacists, Dr Basger decided to intervene personally.

"I thought, I'm going to talk to the patients," he said."I'm going to sit on their beds, talk to them, tell them I'm worried about this medication, and this is why I'm worried about it.

"I'm going to write it all down in plain English and then tell them to go and see their GP.

"Patients were very grateful that I took the time and the interest in them and explained things in terms that were not rocket science.

"The audit of that process, which I published in the study, said 95 percent of patients actioned what I told them; and of those, three-quarters implemented what I recommended, meaning one in five either ceased medications, or reduced the dose."

Dr Basger said the study – titled: 'Uptake of pharmacist recommendations by patients after discharge' and co-authored with Professors Rebekah Moles and Timothy Chen of the University of Sydney – was just the first step, and he hoped to see changes implemented in private hospitals around the country.

"I'm just one person in a small hospital, but the co-operation I get here is just amazing," he said.

"If a pharmacist is trained, has leadership qualities, is supported by management, and understood by staff, and has access to all the medical information, then we can reduce the amount of medication people are taking – making older people's lives safer.

"We can reduce readmission, reduce side effects, reduce falls in older people, and reduce emergency department admissions, as well as reducing the cost to the patient."

Wolper Jewish Hospital General Manager Tina Boger said Dr Basger's work had been a significant benefit to patients.

"Ben is passionate about getting best outcomes for patients. His work ensures safe and co-ordinated patient care. We receive very positive feedback from patients, their carers and doctors regarding the service he provides.

"His work is appreciated by the Medical Advisory Committee and hospital management. We are proud to be able to offer this unique patient centred care service to our patients," she said.

Read more: Will less medication help PTSD patients?

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