An Ecological Approach to Reducing Potentially Inappropriate Medication Use: Canadian Deprescribing Network

Cara Tannenbaum,Barbara Farrell,James Shaw,Justin Turner,James Silvius,Janet C Currie,Paula Rochon,Steve Morgan,Johanna Trimble

doi:10.1017/s0714980816000702

Abstract

Polypharmacy is growing in Canada, along with adverse drug events and drug-related costs. Part of the solution may be deprescribing, the planned and supervised process of dose reduction or stopping of medications that may be causing harm or are no longer providing benefit. Deprescribing can be a complex process, involving the intersection of patients, health care providers, and organizational and policy factors serving as enablers or barriers. This article describes the justification, theoretical foundation, and process for developing a Canadian Deprescribing Network (CaDeN), a network of individuals, organizations, and decision-makers committed to promoting the appropriate use of medications and non-pharmacological approaches to care, especially among older people in Canada. CaDeN will deploy multiple levels of action across multiple stakeholder groups simultaneously in an ecological approach to health system change. CaDeN proposes a unique model that might be applied both in national settings and for different transformational challenges in health care.

Highlights

Polypharmacy is growing in Canada, along with adverse drug events and drug-related costs
The mandate of the Canadian Deprescribing Network (CaDeN) is of relevance to an international audience interested in prescribing best practices, health care transformation, and knowledge mobilization, as it proposes a unique model to achieve changes in health care that might be applied both in new national settings and for different transformational challenges in health care
We examined theories of implementation and health system change to help guide the strategic development of CaDeN

Summary

Introduction

Polypharmacy is growing in Canada, along with adverse drug events and drug-related costs. The purpose of this article is to describe the justification, theoretical foundation, and process for establishing a national network of individuals and organizations interested in the deprescribing of potentially inappropriate medications in Canada: a Canadian Deprescribing Network (CaDeN) This network represents a novel approach to mobilizing knowledge and facilitating practice change on deprescribing by organizing volunteer members into action committees based on a consolidated theory of health services transformation and health care provider practice change (Best et al, 2012; Damschroder et al, 2009; Michie, van Stralen, & West, 2011). The mandate of the CaDeN is of relevance to an international audience interested in prescribing best practices, health care transformation, and knowledge mobilization, as it proposes a unique model to achieve changes in health care that might be applied both in new national settings and for different transformational challenges in health care

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Conclusion