The Canadian Pharmacists Association (CPhA) in partnership with the Choosing Wisely Canada campaign has issued a list of evidence-based recommendations called Six Things Pharmacists and Patients Should Question. In 2016 Canadian pharmacists were enlisted to submit suggested recommendations of unnecessary tests and treatments that they felt needed attention. An expert committee reviewed these submissions to create a final evidence-based list.
The list identifies a variety of commonly used treatments, practices, or therapies that are often initiated or continued even in medically unnecessary situations. In light of this and the fact that they could be potentially harmful to patients these six have been highlighted after careful consideration and research.
- Don’t use a medication to treat the side effects of another medication unless absolutely necessary.
- Don’t recommend the use of over-the-counter medications containing codeine for the management of acute or chronic pain. Counsel patients against their use and recommend safe alternatives.
- Don’t start or renew drug therapy unless there is an appropriate indication and reasonable expectation of benefit in the individual patient.
- Question the use of antipsychotics as a first line intervention to treat primary insomnia in any age group.
- Don’t prescribe or dispense benzodiazepines without building a discontinuation strategy into the patient’s treatment plan (except for patients who have a valid indication for long-term use).
- Don’t renew long-term proton pump inhibitor (PPI) therapy for gastrointestinal symptoms without an attempt to stop or reduce (taper) therapy at least once per year for most patients.
In fact, concern about PPI overuse has grown so much that it was the first drug selected for Deprescribing Guidelines in the Elderly, a project of a group of Canadian health care professionals. The research team offers many tools to help health care providers lower doses or discontinue use for many patients who are on these drugs that have been linked to a wide range of side effects including kidney damage.
The goal of Choosing Wisely is to minimize wasteful or unnecessary medical tests, treatments and procedures, while encouraging dialogue between patients and health care practitioners.
“Choosing Wisely Canada is a natural partnership for CPhA. One of the fundamental ethical principles of the pharmacy profession is that pharmacists will only provide services or products that benefit their patients,” says Phil Emberley, Director, Practice Advancement and Research, CPhA said in a recent press release. “Our involvement sends a strong signal to Canadian pharmacists about their essential role in providing the best possible patient care, while serving as stewards for a sustainable health care system.”
“Choosing Wisely Canada is proud to partner with CPhA and the pharmacy profession. Pharmacists are a vital partner in reducing unnecessary medication use,” says Dr. Wendy Levinson, Chair of Choosing Wisely Canada. “Pharmacists are well positioned to engage in conversations with patients about medications they need, and what they don’t. We are delighted to see this list released and know that it will advance our collective efforts to reduce the harm associated with unnecessary medical tests and treatments.”
Choosing Wisely Canada