MedsAware: Deprescribing Action Week

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


On this page:

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 supports and raises awareness of Australia’s 10th National Health Priority Area, Quality Use of Medicines and Medicines Safety.

Some questions to ask about your medicines 

What medications do I need to keep taking, and why? 

Have any medications been added, stopped or changed, and why? 

How will I know if my medication is working and what side effects do I watch for? 

How will this medicine help me? 

How do I take this medicine and for how long? 

What are the risks of taking this medicine? 

What else can I do? 

I don’t like taking this medicine. I’m worried it’s giving me side effects, or I don’t think it is working. Could you please review it? 

I’m not sure why I take this medicine. Could we talk about this? 

I would like you to please review if I still need this medicine. Could I possibly stop taking this medicine?

Sources:  
https://www.choosingwisely.org.au/assets/NPSMW2464_GMBH_5-QuestionsAboutYourMedicines.pdf
https://www.ismp-canada.org/download/MedRec/5questions/MedSafetyPoster-CaDeN-EN.pdf 
https://onlinelibrary.wiley.com/doi/10.1111/bcpt.13938
 



A message from...

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Dr Mike Freelander MP

For #MedsAware 2024, Mike Freelander MP, Federal Member for Macarthur (NSW) and Chair of the Standing Committee on Health, Aged Care and Sport, discusses the importance of our deprescribing message.

'I fully support MedsAware Week where we think about the medications we're taking and whether it's time to change our prescribing habits and try and change the way that people are taking their medication. And I really congratulate our pharmacists for doing this for our community.'

'It's a great service to the community and very important that we reconsider our medications every year.'

Senator the Hon Anne Ruston

For #MedsAware 2024, Senator the Hon Anne Ruston (SA), Shadow Minister for Health and Aged Care, encourages us to think about the medicines we're taking.

'I'd encourage everybody: have a chat to your family and friends and have a think about whether the medicines that you're taking are the right medicines being taken at the right time for the right condition.'

'And most importantly, seek the advice of your medical professionals, whether that be your GP or your pharmacist, to make sure that your meds are right for you today.'

Senator Hollie Hughes

For #MedsAware , Senator Hollie Hughes (NSW), Shadow Assistant Minister for Mental Health and Suicide Prevention and Deputy Chair of the Joint Standing Committee on the National Disability Insurance Scheme, speaks on medicines-related harm, psycotropic medicines and the importance of deprescribing.

'250,000 Australians are admitted to hospital each year due to medicated-related issues, many of which are preventable, medicines-related harm. We need to break this cycle.'

'If you have any questions about the medicines you or your family are taking, I encourage you to ask your pharmacist, GP or healthcare professional. Ask because you care.'


 

MedsAware webinar

Available until 21 April 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


 

Spread the #MedsAware message!

Help spread the message! Here you can find social media images and posters. Make sure to tag SHPA and use the hashtag #MedsAware in your posts.

Campaign resources

Purple Pen Podcast episode159 - Deprescribing psychotropics with Dr Mark Horowitz

The Purple Pen Podcast - named for the pen colour of choice for hospital pharmacists - is a podcast produced for, but not limited to, pharmacists and health professionals. Their latest episode, Deprescribing psychotropics with Dr Mark Horowitz, has been released to coincide with MedsAware 2024.

Join Kristin as she talks with Dr Mark Horowitz about how to deprescribe psychotropics like antidepressants, what is known about the causes of depression, what evidence is behind the antidepressants commonly used, what the symptoms of antidepressant withdrawal look like and the origins of the phrase "it's Bedlam here."

Listen to the episode →

The episode will be available on Spoitfy and Apple Podcasts on Sunday 16 March 2024.

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

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

ADeN Acting Chair Dr Lisa Kouladjian O’Donnell says as people age, their priorities and life values change, and their medicine regimen should reflect their goals of care. 

‘Medicines that were once beneficial, but no longer appropriate or interferes with a person’s current goals of care, may need to be deprescribed.

‘Deprescribing can reduce medicine-related harms, and the burden to individuals, to optimise outcomes for Australians.’ Picture of Lisa attached.

—  ADeN Acting Chair, Dr Lisa Kouladjian O’Donnell

An important aspect of medication safety is ensuring that patients do not continue to take medicines after they’re no longer required and that the benefits of taking any medicine outweighs the risks. This is a fundamental role of pharmacists as the experts in medicines. FIP fully supports the SHPA MedsAware campaign to raise awareness of the benefits of appropriate deprescribing, particularly in cases of polypharmacy. As our older populations grow, this facet of pharmaceutical care will become even more significant. FIP has developed a number of resources to empower the profession with skills in medication review.

— FIP CEO, Dr Catherine Duggan

‘Upholding the quality use of medicines is the responsibility of all doctors. Our most vulnerable patients, including those with a disability and older Australians are at risk if regular reviews of their medicines aren’t undertaken by those responsible for their care.’

— AMA President, Professor Steve Robson

COTA Chief Executive Officer, Patricia Sparrow, says a national focus on deprescribing which centres the needs of patients is important. 

It's crucial that older Australians are supported to have conversations about reviewing, reducing or discontinuing their medicines. 

This isn't about stopping medication, it's about encouraging conversations and making sure older people are getting the right medications they need to live life the way they want and deserve to. 

We need a system that places patients at the centre of the conversation through safer, shared decision making and sees patients, pharmacists, doctors and nurses all working together in the best interests of the patient.

— COTA Chief Executive Officer, Patricia Sparrow

Research suggests that one-quarter of people on multiple medicines have adverse effects directly attributable to the additive effects of those medicines.1  To ensure quality use of medicines is maintained, it is important to have embedded a structured, medicines stewardship-based approach to medicine review and deprescribing.  This approach should be collaborative, actively involving the patient in the decision making process with an aim to optimise treatment and minimise potential risks. 

In recognition of the importance of deprescribing, CATAG is part of the Medicines Advice Initiative Australia(MAIA) consortium. MAIA provides high quality, data-driven educational materials for health professionals, to aid them in solving pressing current issues around medicine use. CATAG will soon be releasing a practice tool and teaching tool to help address the hidden risk of cumulative medicines and encourage appropriate deprescribing as an active constituent of hospital care.

—  CATAG Chair, Anita Shutt

Dr Nicole Higgins, says it is a complex area of medicine that required careful management.

‘The goal of deprescribing is to improve a person's quality of life by reducing the amounts and types of medicines to reduce the risks of complications such as falls and cognitive impairment,’ she says.

‘There are many other strategies that we have to assist people with behavioural challenges before we reach for the prescription pad. This is a complex area and there is no single solution.’

—  RACGP President, Dr Nicole Higgins


Proudly supported by:

Australian Deprescribing Network Australian Deprescribing Network Australian Deprescribing Network
Australian Deprescribing Network Australian Deprescribing Network

Australian Deprescribing Network

Australian Deprescribing Network

Australian Deprescribing Network

Australian Deprescribing Network (ADeN)

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 ADeN on X: @DeprescribeAU

Australian Deprescribing Network

International Pharmaceutical Federation (FIP)

The International Pharmaceutical Federation (FIP) is the global body for pharmacy, pharmaceutical sciences and pharmaceutical education. Through our 156 national organisations, academic institutional members and individual members, we represent over four million pharmacists, pharmaceutical scientists and pharmaceutical educators around the world. Click here for the history of FIP.

Australian Deprescribing Network

Royal Australian College of General Practitioners (RACGP)

The Royal Australian College of General Practitioners (RACGP) is the peak representative organisation for general practice, the backbone of Australia’s health system. We set the standards for general practice, facilitate lifelong learning for GPs, connect the general practice community, and advocate for better health and wellbeing for all Australians.

Australian Deprescribing Network

Council on the Ageing (COTA)

COTA Australia is the leading advocacy organisation for older people.

cota.org.au

Australian Deprescribing Network

Registry of Senior Australians (ROSA)

The Registry of Senior Australians (ROSA) is a national multisectoral integrated data platform designed to monitor and evaluate the health, service use, social welfare, medication use, mortality, and other outcomes of >3.5 million people who received or are receiving aged care services nationally.

rosaresearch.org

Australian Deprescribing Network

Council of Australian Therapeutic Advisory Groups (CATAG)

CATAG is a collaborative incorporating all Australian State and Territory Therapeutic or Medicines Advisory Groups. CATAG is an expert and consensus-based collaboration that influences clinical governance so that a quality use of medicines approach is considered in both policy and practice. CATAG is dedicated to optimising medicines use and promoting the safe, effective, equitable and sustainable use of medicines. CATAG facilitates information and knowledge exchange, provides guidance, and advocates for best practices in therapeutic decision-making.

catag.org.au

Australian Deprescribing Network

Australian Medical Association (AMA)

The Australian Medical Association (AMA) is the peak professional body for doctors in Australia. 

The AMA promotes and protects the professional interests of doctors and the healthcare needs of patients and communities. 

Representing doctors, the AMA works with governments to develop and influence health policy to provide the best outcomes for doctors, their patients, and the community.

The AMA represents and supports all Australian doctors and medical students. They are member-run and led, fighting for fairness and equality, and lobby and campaign on the issues affecting the medical profession.

ama.com.au


Resources and publications

Australian Deprescribing Network (ADeN)

The Australian Deprescribing Network (ADeN) comprises of 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.

Choosing Wisely Australia (choosingwisely.org.au)

The Choosing Wisely Australia initiative is helping the healthcare community and consumers to start important conversations about unnecessary and sometimes harmful tests, treatments and procedures. We are here to support consumers to make informed decisions in partnership with their healthcare professionals in ways that suit their own preferences and personal circumstances. Choosing Wisely is challenging the notion that ‘more is always better’. The right choice should be based on the best available evidence and discussion between you and your healthcare team.

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.