There’s no single solution to the problem of adverse drug events and/or over- and under-medication. What’s needed is a greater recognition of the problems caused by polypharmacy, and a move to reduce prescription of unnecessary medicines involving patients and health professionals, as well as systemic changes.
Geriatrician Professor David Le Couteur recommends the following strategies.
- Have a single doctor — usually your GP — manage and oversee all your medical issues and medications.
- If any new symptom occurs, consider whether this might be due to an adverse reaction to a medication.
- Discuss with your doctor (or pharmacist) whether new medications are justified and current medications still required.
Conduct a medicine audit
It’s important to regularly assess all the medicines you’re taking — not just prescription products, but also over-the-counter and herbal medicines, and even dietary supplements. This can reduce the likelihood of interactions, or taking unnecessary or inappropriate medicines.
The US has “brown-bag days”, where elderly people take all their medicines to their doctor to check for necessity and inter-drug interactions, as well as expired use-by dates. This simple but effective approach could be useful here.
People whose medication regime puts them at risk of misadventure — including polypharmacy, age, recent hospitalisation, recent changes to medication and/or having multiple doctors – are entitled to a Medicare-funded Home Medicines Review. In cooperation with the patient’s GP, a suitably qualified pharmacist visits the patient at home, reviews their medication regimen and provides the GP with a report. The GP and patient then agree on a medication management plan. Talk to your doctor or pharmacist about this service.
Be fully informed
Take them only as directed. If your doctor hasn’t explained how they should be taken, or you’ve forgotten, ask the pharmacist. For complex medication regimes, ask the doctor or pharmacist to put it in writing.
Read the prescription label when you get the medicine, and confirm your understanding of it with the pharmacist. If it’s a new medicine, make sure you’re aware of any possible side effects. Ask for the CMI leaflet if it’s not included with the medicine. If your new medicine makes you feel unwell, tell your doctor. Inform your doctor of all medicines you’re taking, including over-the-counter medicines and herbal remedies and supplements. They may seem harmless because they’re not prescribed, but they can interact with other medicines.
Ask your doctor about lifestyle changes that may help reduce the need for medication. The majority of the 10 most commonly prescribed PBS medicines – the ones the government pays for – are for conditions that can be caused by poor lifestyle choices, or managed with appropriate lifestyle changes. According to the latest figures:
- Medications to reduce high blood pressure and treat angina comprise three of the top 10 medicines prescribed. Poor diet, overweight, smoking, excessive alcohol and lack of exercise all contribute to high blood pressure and heart disease.
- Proton pump inhibitors, taken to reduce the effects of gastro-oesophageal reflux and stomach ulcers, make up three of the top 10 medicines prescribed and cost the taxpayer more than $250 million per year. Dietary factors, cigarettes, alcohol, obesity and overeating can cause reflux, or make it worse, as can medications for blood pressure, anticholinergics and anti-inflammatories.
- Two of the top 10 medicines prescribed are statins, costing taxpayers over $1 billion per year. They’re taken to reduce cholesterol levels and the risk of heart disease. Lifestyle improvements, including a better diet and more exercise, could substantially reduce this bill.
- Medication for managing type 2 diabetes, the latest lifestyle-related disease epidemic, comes in at number 10, with 2.7 million prescriptions per year.
These illnesses and conditions can’t always be prevented or managed with lifestyle changes, but a high proportion can. People often find it more convenient to “pop a pill” than change their lifestyles, and doctors know that withholding medicine will simply mean ill-health and higher costs further along the line in the form of hospital admissions, disability and premature death.
The National Prescribing Service is a government-funded body responsible for providing health professionals and members of the public with information and advice about medicines. It has a lot of useful information for consumers, including the printable, wallet-sized Medicines List and Consumer Medicine Information.