Over the past year, a team with the Island Health renal program evaluated a novel clinical tool designed to help decrease the number of unnecessary medications taken by people on hemodialysis, who often have a very high pill burden. The results could support more patients in safely stopping or tapering off medications they no longer need, in turn leading to better health outcomes, lower healthcare costs, and even environmental benefits.
People on hemodialysis take an average of 12 medications per day, some of which may be unnecessary and cause undesirable side effects. For example, some patients may be prescribed a medication for acid reflux that is only needed short-term, but they continue to take the medication for longer than necessary.
To help address this problem, a team of researchers based in Toronto created a tool that health care workers can use to review hemodialysis patients' medications and identify ones that could be safely stopped. Several hospitals are now enrolling in a multi-centre trial to explore how the tool, called STOP-MedHD, can be implemented more broadly across Canada.
Dan Martinusen is a clinical pharmacy specialist with Island Health, who helped oversee the implementation of STOP-MedHD at the Royal Jubilee Hospital in Victoria, BC. “We thought this was not only a good avenue for improving patient care, but also – by having patients on fewer medications – there's less of an environmental impact and better resource utilization," he explains, noting that medications are costly and associated with high carbon emissions to manufacture and transport.
Although the results of the study are still being analyzed, Martinusen highlights several initial insights gained so far. He notes that of the approximately 175 patients at the Royal Jubilee Hospital who were asked to participate in the study, more than half agreed. This could indicate a desire among many people on hemodialysis to cut back on unnecessary medications. As well, clinicians have generally reported that STOP-MedHD is easy to use, meaning it could potentially be a viable tool for wider use.
Martinusen says that, while a small handful of patients had to restart medications that were initially stopped, the study resulted in an overall reduction in medications prescribed.
The initial results also show that care providers at the Victoria site are already doing a good job overall at prescribing medications. “By and large, I had some comfort that we were on the right track – we could tweak medication use here and there a little bit, but we are already fairly focused on providing people optimized therapy," Martinusen notes.
He notes that the findings from this study may help inform ways to safely reduce medication use more broadly for kidney patients across BC. As well, Martinusen and some of his colleagues are interested in exploring the environmental impacts of reduced medication use in future work.
Study: Clinical Integration and Evaluation of the STrategic Optimization of Prescription Medication Use in Patients on HemoDialysis (STOPMed-HD) Intervention
Stop-MedHD Tool: https://www.stopmedhd.ca/
