Deprescribing with Barbara Farrell, PharmD, for more than 20 years.

Deprescribing in elderly persons has been the focus of research by Barbara Farrell, PharmD, for more than 20 years. Dr Farrell is a clinical scientist at the Bruyère Research Institute and the C.T. Lamont Primary Health Care Research Centre, and assistant professor in the Department of Family Medicine, University of Ottawa, Canada. She is a cofounder of the Canadian Deprescribing Network and codeveloper of deprescribing.org, a website for the dissemination and exchange of information about deprescribing approaches and research. Dr Farrell discussed her work to increase awareness about deprescribing with Medscape for this first article in our new series on the topic. 
 http://ift.tt/2qZ6Dop

          So, Dr. Farrel study more then 20 years how medicine Rx or disRx for elderly persons over 65 years old, right? It is OK to have this discussion with someone who does not re-new Rx every three month. It is looks like ugly humor for every one who do it. Just think about, why do I need to go to clinic every three month to renew medicine I take one year after another for at least 10 or 20 last years? Why do I need doctor Rx for this? It would be more effective for society that we avoid trips to medical clinic and just call to pharmacy we need that medicine, right?
        Really, I still not able to get the topic of discussion, why it is so new in Medscape?
Naivelly I thought that doctor check up medicine I take every time doctor discuss it with me in office. Everey time after clinic I got summary of my last visit. What is in this summary? The name of medicine I take. ????????????? What is so important in this summary? Do I know or I do not know what medicine I do take right now? Really I do. This is why when I see in list medicine which was stopped three years ago I am really surprised, where this come from? Even more then this I am so surprised to find out that I still to take medicine such as antibiotic I took three month ago when I was at home after hospital. Does doctor understand that this medicine cannot be taken more then 10 days? It is three months after it was initially Rx.
       So, there question stands, What is the work of Dr. Farrel about?

A recent survey among older adults in 11 countries reported the highest rates of multiple conditions, such as hypertension, heart disease, diabetes, lung problems, mental health problems, cancer and/or joint pain and arthritis, in the United States (68%) and Canada (56%) compared with European countries and Australia. Rates of 80% were reported from studies that also included such comorbidities as hyperlipidemia and allergies. As a result, older adults are likely to be prescribed multiple medications (polypharmacy) and utilize more healthcare, at a higher cost, compared with patients with no or fewer chronic conditions.

 I can do this study, just let me be paid. I do know from all my life, when I am not sick I do take less medicine then I am ill. Right now because of my health condition is so down I need more and more medical attention then I needed even 30 years ago when I still do not have stroke and MI, even I did have diabetes, not diagnosed of cause.

Polypharmacy and potentially inappropriate medications in older individuals are associated with adverse drug events, death, impaired physical and cognitive function, falls, and hospitalization.

To discuss this topic why do not start with simple question, Why in Older Patients Medication is Inappropriate? I would understand if it was the topic of discussion, but it is not. The topic is, how many medicine names elderly patients take.

Many over-65s take five or more prescription drugs, and this rate is increasing.

        Why this is so surprising? If I am diabetic then diabetes effect all my body, heart and lungs, bones and blood vessels. Right now it is swelling, severe water retention and blockage of blood vessel. My legs are swelled, and my left leg has broken vein which is leaking. Only this issue demand special medical attention, wounds dressing, inflammation prevention, decompression wraps and socks, antibiotics, and so on. It even lead me into ER. Not all this I simple not able to walk. The question is Why? Because of in 2013, in May, Rx to 260 units of insulin was canceled, and I hardly was able to survive. One day I was in hospital and doctor handle Rx to insulin into my hands. Very next day it was call from pharmacy, doctor canceled Rx to insulin. Next regular insulin supply  was only in January 2014. I never was able to fully recovery after this drop.
       I am so in panic every time when I see any mail from my pharmacy right now, or from insurance company. It is panic that I out of insulin, and I cannot afford to pay for my life.
       There is another part of discussion. Insulin. It is only one name in medical topic. The price is not the amount of names, but it is amount of medicine I need. I need 300 units every day. It is one pen, 307 units in each pen. I take three or four shots daily. 2 units to spring needle. I do not do it. It is 2 units every time I push bottom. 8 units every day. 240 units every month, almost one pen. There are 5 pens in one box. The price is about $450 for each box, depending from the pharmacy and place diabetic live. In other words, it is $90 each pen. How many of you will push $90 just to waste? Not I anyway.
        In addition I need needle every time I push bottom. I do use needles which I can re-digit. Some needles are not allow to be used twice. I do not use these needles. I use those needles I can push into my belly for many times. Remember, each needle cost money.  I use one lancet for last three years. It still working, so why do I need to pay $87  for each box of lancets? I do not need it. I use simple paper to cover the shot of the finger. I can use toilet paper for this purpose. It is also good and wise to safe money. Medical Care named it 'cost effective therapy'. But strips I cannot use twice. I need a new every time, and I need many of them every day.
       So, the therapy is only one name, 'insulin therapy' but the names of medicine is many: insulin in appropriate dosing, needles in amount of every day shots, strips, lancets, alcohol swaps. It is much easy with oral medicine. Just one name, Metformin, and no any add-on supply. Only one problem with metformin. After awhile there are more and more add-ons such as amputations, home aids, scooters, wheelchairs, OT, ST, Nursing Homes, and so so on. This is effect of cost.

 Dr Farrell notes that at her hospital in Ottawa, it is not unusual to see a patient on 25-30 medications.

 Well, let us take another look at the patients in hospital where Dr. Farrell did the job. From 25 to 30 medications how many of them patient need? How many of them were stopped in hospital after patient was discharged? How many new were added? I would understand if it was topic of discussion, it is not. It is not the topic of Dr. Farrell study if all those patients take medicine they need, or they need different medicine, or they need different dose of the same medicine, or they need simple more then they already do have. Not at all. The topic is What? Amount of names of medications. Pointless topic, but really very very profitable. No responsibility, no any fear to get to the court, but just discuss that practitioners do job in not appropriate way. Sorry, Dr. Farrell, at least the do the job, and you are not. No one will miss you if you will get fired. You work is inappropriate.

I see patients in their 80s and 90s who have been on a medication for 30 years, and no one can remember why they are taking it."

       The question is, who suppose to remember why medication taken? Doctor? Doctor should not remember why it is taken, doctor simple must know if this patient needs this medication or not. If doctor do not know then what kind of medical care do we have? Only Dr. farrells why count names and do not know what these names stand for. If patient must to remember then say me, why? If 90 years old able to remember own name I would say, one has right medicine patient needs. Does not matter how many names of it, patient alive and functional. Diabetics who denied Insulin cannot survive for 90 years. Check it up in CDC, in what age diabetics type 2 usually gone. All is only because of we do not have only one medicine we need, insulin. We all do have from 25 to 390 different names of medicine, but not insulin.

 Deprescribing has earned widespread attention because it is an active word, rather than a description of the problem (such as "polypharmacy"), Dr Farrell suggests. She stresses that deprescribing must be directed and supervised by a healthcare professional, at the same level of expertise as prescribing, and should not be confused with nonadherence or noncompliance.

So, one doctor would Rx insulin to me. But insulin is not cost effective. It is effective medicine, it is long term medicine, and at age of 90 probably I would not remember when and who Rx it to me, and why do I need to take the shot into my belly every morning and every eve, and another doctor would Deprescribe it to me, and I still not able to get why do I feel so bad, why my mouth is so dry that I cannot say the word, and why I cannot rise my hands. I simple would not be able to check up that my blood sugar is higher then 900 mg/dl. Where all these talks come from?

Although the term "deprescribing" (defined as reviewing and identifying medications to be stopped, substituted, or reduced) first appeared in the literature in 2003, the problem of polypharmacy in the elderly has been recognized for 30 years, Dr Farrell points out. 

OOOOO, I got it! Because more and more sons and daughters of medical pro come to field they all need own place to stay and own spot to shine. According to Hypocritical Oath   they all have to be provided with appropriate income. So, new terms need to be developed, and new topics must be discussed.

Lists of potentially inappropriate medications that can be used as tools for deprescribing in older adults include the Beers criteria, as recently updated by the American Geriatrics Society, and STOPP (Screening Tool of Older Persons' Prescriptions)/START (Screening Tool to Alert doctors to Right Treatment). Application of these tools has been shown to reduce the use of these agents, but it is unclear whether they significantly improve such outcomes as hospital admissions, medication-related problems, or overall quality of life.  

 Do I really need to continue? Of cause it is the time to jump to the conclusion. Stop to trust that doctor do know what he is doing. As Dr. Farrell show up, it is not the case. With info so widely available right now it is time to take own life in own hands, and keep it there.
      Personally, I do not count the name of medicine I take. I take better care if I do have medicine I need, and try to be careful to take all what doctor Rx as it is important part of my treatment plan. If cardiologist try to cut dose of insulin I take, or simple cut it all and Rx Metformin instead I do not follow doctor's order. Cardiologist is not endo, so he cannot stop insulin in my regime. Interesting, why cardio doctor do not see I need Caumadine, but very very sure I do not need insulin? I would like to ask Dr. Farrell this question. So sad, there would not be appropriate answer.

via Ravenvoron