Newfoundland and Labrador (NL) is among the highest users of inappropriate medication across Canada. The NL Department of Health and Community Services has agreed to fund a three-year implementation and evaluation project, in which pharmacists, physicians and the public will work collectively towards reducing the prevalence of inappropriate medications.
A key component will be engaging community pharmacists to identify patients who take potentially inappropriate medications and work with these patients and their physicians to safely discontinue (or deprescribe) these medications to improve the health of Newfoundlanders and Labradorians. The funding allocated for this project by the government will support a public awareness campaign; however, no funding has been allocated to deliver pharmacist education for this initiative. The School of Pharmacy is best suited to lead this role by engaging NL pharmacists to understand their education and practice support needs, and to meet these needs through adaptation and dissemination of evidence-based tools to support deprescribing using an academic detailing approach.
Academic detailing is essentially outreach education for health professionals. Both individual and group level academic detailing are effective in improving appropriateness of care. Research has demonstrated the benefit of involving community pharmacists in the discussion on appropriate medication use. The D-PRESCRIBE trial demonstrated a 45% reduction in inappropriate medication use by community dwelling older adults. This was achieved by engaging pharmacists to educate patients about the benefits and risks of inappropriate medications, and to provide appropriate pharmacological and non-pharmacological alternatives.
This project will address the education needs of pharmacists in two steps. First, a group of local opinion leaders will be convened to review evidence-based materials and provide guidance on how these can be implemented in the local context of NL. The second step will involve individual and group level academic detailing of community pharmacist across the breadth of NL.
A key component to improving medication use across Newfoundland and Labrador (NL) is engaging community pharmacists to identify patients who take potentially inappropriate medications and work with these patients and their prescriber to safely discontinue (or deprescribe) these medications. To achieve this and ensuring healthcare providers are sharing the same message at the same time we undertook a number of activities including:
1. Engagement of local opinion leaders from across the province to convene and review evidence-based materials and provide advice on how to modify them to the NL context
2. Individual and group level academic detailing of healthcare providers
3. Hosted pharmacy student focus group to seek feedback from practice site work terms on how to improve the implementation of deprescribing in community pharmacies
4. Hosted a virtual, interprofessional session for pharmacists and prescribers promoting the appropriate use of medications including, Proton Pump Inhibitors and sedative-hypnotics for insomnia.