Choosing Wisely: six recommendations

The Pharmaceutical Society of Australia (PSA) has issued six recommendations on what not to do when dealing with the issue of multiple medicines and complementary medicines including homeopathy.

The PSA’s inaugural Choosing Wisely list of recommendations for Australians to consider around medicines use is intended to reduce medication misadventure with about 230,000 Australians admitted to hospital as a result of medication misadventure each year.

This is around four times the annual number of people who are hospitalised as a result of motor vehicle accidents and costs the Australian health system $1.2 billion each year, yet 23% of adverse drug events in primary care are preventable.

NPS MedicineWise Client Relations Manager, Dr Robyn Lindner, said: “Sometimes people are unsure of what medicines they’re taking and why. We encourage you to discuss the implications of each new medicine with your healthcare provider and ensure you are fully informed about issues such as necessity, risks and side effects.”

PSA National President Dr Chris Freeman said “While the use of medicines offers significant benefits for many people, they may also cause unnecessary harm. It is important that we balance the positive and negative effects of each medicine, tailored to each individual with their care goals front of mind.

“As experts in medicines, pharmacists have the ability to provide specialised review of a person’s medication regimen, resulting in recommendations or actions to help people get the most out of their medicines. Any person taking multiple medicines, high-risk medicines, or who is at high risk of medicine misadventure, including transitioning between care settings, should have their medicines reviewed,” he said.

“In regards to homeopathic products there is no reliable evidence of efficacy. All health professionals should take the time to discuss with health consumers who are taking or considering taking these products, the lack of efficacy and the risks in rejecting or delaying other treatments known to be safe and effective.

“Prescribing data shows that close to 25% of repeat antibiotic prescriptions were dispensed more than four weeks after the initial dispensing, indicating potentially inappropriate antibiotic use in the community. Pharmacists can help to reduce the burden of antibiotic resistance by first clarifying the clinical appropriateness of repeat antibiotic prescriptions before dispensing.”

The six PSA recommendations are:

  1. Do not initiate medications to treat symptoms, adverse events, or side effects (unless in an emergency) without determining if an existing therapy or lack of adherence is the cause, and whether a dosage reduction, discontinuation of a medication, or another treatment is warranted.
  2. Do not promote or provide homeopathic products as there is no reliable evidence of efficacy. Where patients choose to access homeopathic treatments, health professionals should discuss the lack of benefit with patients.
  3. Do not dispense a repeat prescription for an antibiotic without first clarifying clinical appropriateness.
  4. Do not prescribe medications for patients on five or more medications, or continue medications indefinitely, without a comprehensive review of their existing medications, including over-the-counter medications and dietary supplements, to determine whether any of the medications or supplements should or can be reduced or discontinued.
  5. Do not continue benzodiazepines, other sedative hypnotics or antipsychotics in older adults for insomnia, agitation or delirium for more than three months without review.
  6. Do not recommend complementary medicines or therapies unless there is credible evidence of efficacy and the benefit of use outweighs the risk.

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