Clinical Pharmacologists are calling on medical professionals to stop the “prescribing cascade” of unnecessary and potentially harmful medication use in Australia and Aotearoa New Zealand.
President of the Royal Australasian College of Physicians (RACP) and clinical pharmacologist Professor Jennifer Martin said new guidelines released by the RACP aim to reduce concerning prescription practices and make healthcare more effective and safer for patients.
"Overprescription is creating avoidable risks. This is especially true for older patients.
"Over 40 per cent of Australians aged 75 and older are currently prescribed more than five medicines [1], Professor Martin said.
The Royal Australasian College of Physicians (RACP) and the Australian Society of Clinical and Experimental Pharmacologists and Toxicologists (ASCEPT) have developed new low-value care guidelines under the RACP's Evolve program that urge medical professionals to re-evaluate prescribing medications that offer no benefits to patients and risk unintentional harm.
"Many patients experience a 'prescribing cascade,' where the side effects of one medicine can be misdiagnosed as a new condition, which may in turn lead to further unnecessary prescriptions,” Professor Martin said.
"We're calling on medical professionals to rethink how and when they prescribe medications to patients.
"It is vital that medical professionals prioritise safer non-medication treatments when they're equally or more effective and only prescribe medications when required," Professor Martin said.
ASCEPT President Associate Professor Bridin Murnion said the recommendations also address the risks associated with off-label prescribing, where medications are prescribed for purposes outside the Therapeutic Goods Administration (TGA) approved conditions for age, therapeutic indication, dosage, route and timeframes.
"Medical professionals are urged to consider the ethical and legal issues linked with off-label medicine use, especially in cases where there's insufficient evidence”
"These guidelines call on medical professionals to only recommend off-label use to patients when there's robust evidence to support it, when informed consent has been taken and when outcomes are closely monitored.” Associate Professor Murnion said.
The updated Evolve guidelines identify five key areas where prescribing practices can improve:
- Carefully avoiding prescribing cascades
- Prioritising non-medication treatments when equally effective
- Using off-label medications only when supported by strong evidence
- Prescribing the minimum effective dose and monitoring for toxicity
- Avoiding prescribing medications where the risks outweigh the potential benefits
"These recommendations are about ensuring that medications contribute to better patient outcomes and avoid unnecessary harm," Associate Professor Murnion said.
To learn more about the ASCEPT Evolve Top-5 recommendations, please visit our webpage: Aust Soc of Clinical & Experimental Pharmacologists & Toxicologists
[1] Australian Commission on Safety and Quality in Health Care – Polypharmacy