Around 10% of medication is overprescribed in primary care, so there’s real opportunity to improve medication appropriateness, says NHMRC fellow Dr Aili Langford.
Seeing specialists can leave patients with a concoction of medications, but GPs can make sense of it all, says RACGP president Dr Michael Wright.
Today, Advanced Pharmacy Australia, formerly the Society of Hospital Pharmacists of Australia, held a webinar on safe and sustainable use of medicine, focusing on deprescribing.
Deprescribing, as per the RACGP’s guidelines, involves the planned withdrawal of medicines that are no longer beneficial or may be causing harm, conducted under medical supervision.
Dr Wright said the college was supportive of reducing unnecessary, or possibly even harmful, medications, but that it was important that deprescribing was done in collaboration with a doctor or a pharmacist.
“Getting the right mix of medicines for people with multiple long-term conditions is complex, and people who see different specialists often end up with a big collection of medicines,” he said.
“Specialist GPs are trained in patient-centred care and as generalists we support our patients to make sense of it all, and what is best for them.”
Last year, the RACGP endorsed evidence-based guidelines on the safe deprescription of antidepressants, benzodiazepines, gabapentinoids and z-drugs, the Maudsley Deprescribing Guidelines.
The college’s Silver Book, focused on treating older patients, outlines good deprescribing practice, noting that it should be part of good prescirbing at all stages of life.
Speaking at the webinar, NHMRC emerging leadership fellow Dr Aili Langford said that the environmental impact of deprescribing was often not considered.
A report published in the BMJ in 2021 found that approximately 10% of medication in primary care was over prescribed in the UK.
“So there’s a real opportunity there to improve medication appropriateness through deprescribing,” said Dr Langford.
“A recent study looked at the potential of deprescribing in terms of greenhouse gas emissions.
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“They did a modelling study where they estimated a 5% reduction in drug consumption in quite a small hospital setting. In a 200-bed hospital, it could lead to a reduction of over 100 tonnes of greenhouse gas emissions per year.
“Whilst this may seem relatively small scale, I think it really speaks to the potential large-scale impacts, if deprescribing is done well and done appropriately in our local settings, how that could have quite substantial flow on effects.
“Just to contextualise that previous statistic, that reduction is equivalent to around 4000 car trips of 100km.”
Currently, healthcare represents 7% of the total carbon dioxide emissions in Australia, with pharmaceuticals contributing to 19% of the sector’s emissions, said Dr Langford.
She said there were many ways, including deprescribing, that individual healthcare workers could reduce these emissions.
“For those who work in a hospital setting, perhaps it’s using patients own drugs during their inpatient hospital stay, rather than dispensing new packages.
“I know there’s probably some local policy level considerations regarding that as well, but a potential strategy [is] providing smaller supplies of new medications or starter packs when someone is initiating a medication, whilst they may still be titrating doses or determining the appropriateness, efficacy or safety of the medication, and this can mitigate waste from poor tolerability.
“And then finally … regular medication review with appropriate deprescribing.”
Founding member of AdPha’s climate and health specialty practice group Grace Wong said that deprescribing was a benefit to all.
“Deprescribing is a “win-win” action – reduction in medication misadventure risk and financial cost for patients, and reduction in environmental impact of the manufacture, use and disposal of medicines,” she said.
Dr Langford called on pharmaceutical companies to share more information about the environmental impacts of their medications.
