Discontinuing Medications: A Novel Approach for Revising the Prescribing Stage of the Medication-Use Process

Authors

  • Kevin T. Bain PharmD,

    1. From the *Department of Quality Outcomes, excelleRx Inc., an Omnicare Company, Philadelphia, PennsylvaniaDepartment of Health Policy, University of the Sciences in Philadelphia, Philadelphia, PennsylvaniaDepartment of Medicine, Baylor College of Medicine, Houston, Texas (affiliation at the time of drafting and revising)§Department of General Internal Medicine, Ambulatory Treatment, and Emergency Care, M.D. Anderson Cancer Center, University of Texas, Houston, Texas (affiliation at the time of final revising and approval)Miller School of Medicine, University of Miami, Miami, Florida#Department of Health Policy, Jefferson Medical College, Philadelphia, Pennsylvania**Division of Geriatric Medicine and Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania††Department of Medicine, Division of Clinical Decision Making, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts.
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  • Holly M. Holmes MD,

    1. From the *Department of Quality Outcomes, excelleRx Inc., an Omnicare Company, Philadelphia, PennsylvaniaDepartment of Health Policy, University of the Sciences in Philadelphia, Philadelphia, PennsylvaniaDepartment of Medicine, Baylor College of Medicine, Houston, Texas (affiliation at the time of drafting and revising)§Department of General Internal Medicine, Ambulatory Treatment, and Emergency Care, M.D. Anderson Cancer Center, University of Texas, Houston, Texas (affiliation at the time of final revising and approval)Miller School of Medicine, University of Miami, Miami, Florida#Department of Health Policy, Jefferson Medical College, Philadelphia, Pennsylvania**Division of Geriatric Medicine and Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania††Department of Medicine, Division of Clinical Decision Making, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts.
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  • Mark H. Beers MD,

    1. From the *Department of Quality Outcomes, excelleRx Inc., an Omnicare Company, Philadelphia, PennsylvaniaDepartment of Health Policy, University of the Sciences in Philadelphia, Philadelphia, PennsylvaniaDepartment of Medicine, Baylor College of Medicine, Houston, Texas (affiliation at the time of drafting and revising)§Department of General Internal Medicine, Ambulatory Treatment, and Emergency Care, M.D. Anderson Cancer Center, University of Texas, Houston, Texas (affiliation at the time of final revising and approval)Miller School of Medicine, University of Miami, Miami, Florida#Department of Health Policy, Jefferson Medical College, Philadelphia, Pennsylvania**Division of Geriatric Medicine and Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania††Department of Medicine, Division of Clinical Decision Making, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts.
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  • Vittorio Maio PharmD, MS, MSPH,

    1. From the *Department of Quality Outcomes, excelleRx Inc., an Omnicare Company, Philadelphia, PennsylvaniaDepartment of Health Policy, University of the Sciences in Philadelphia, Philadelphia, PennsylvaniaDepartment of Medicine, Baylor College of Medicine, Houston, Texas (affiliation at the time of drafting and revising)§Department of General Internal Medicine, Ambulatory Treatment, and Emergency Care, M.D. Anderson Cancer Center, University of Texas, Houston, Texas (affiliation at the time of final revising and approval)Miller School of Medicine, University of Miami, Miami, Florida#Department of Health Policy, Jefferson Medical College, Philadelphia, Pennsylvania**Division of Geriatric Medicine and Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania††Department of Medicine, Division of Clinical Decision Making, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts.
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  • Steven M. Handler MD, MS,

    1. From the *Department of Quality Outcomes, excelleRx Inc., an Omnicare Company, Philadelphia, PennsylvaniaDepartment of Health Policy, University of the Sciences in Philadelphia, Philadelphia, PennsylvaniaDepartment of Medicine, Baylor College of Medicine, Houston, Texas (affiliation at the time of drafting and revising)§Department of General Internal Medicine, Ambulatory Treatment, and Emergency Care, M.D. Anderson Cancer Center, University of Texas, Houston, Texas (affiliation at the time of final revising and approval)Miller School of Medicine, University of Miami, Miami, Florida#Department of Health Policy, Jefferson Medical College, Philadelphia, Pennsylvania**Division of Geriatric Medicine and Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania††Department of Medicine, Division of Clinical Decision Making, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts.
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  • Stephen G. Pauker MD

    1. From the *Department of Quality Outcomes, excelleRx Inc., an Omnicare Company, Philadelphia, PennsylvaniaDepartment of Health Policy, University of the Sciences in Philadelphia, Philadelphia, PennsylvaniaDepartment of Medicine, Baylor College of Medicine, Houston, Texas (affiliation at the time of drafting and revising)§Department of General Internal Medicine, Ambulatory Treatment, and Emergency Care, M.D. Anderson Cancer Center, University of Texas, Houston, Texas (affiliation at the time of final revising and approval)Miller School of Medicine, University of Miami, Miami, Florida#Department of Health Policy, Jefferson Medical College, Philadelphia, Pennsylvania**Division of Geriatric Medicine and Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania††Department of Medicine, Division of Clinical Decision Making, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts.
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Address correspondence to Kevin T. Bain, PharmD, BCPS, excelleRx, Inc., an Omnicare Company, 1601 Cherry Street, Suite 1700, Philadelphia, PA 19102. E-mail: kbain@excellerx.com

Abstract

Thousands of Americans are injured or die each year from adverse drug reactions, many of which are preventable. The burden of harm conveyed by the use of medications is a significant public health problem, and therefore, improving the medication-use process is a priority. Recent and ongoing efforts to improve the medication-use process have focused primarily on improving medication prescribing, and not much emphasis has been put on improving medication discontinuation. A formalized approach for rationally discontinuing medications is a necessary antecedent to improving medication safety and improving the nation's quality of care. This article proposes a conceptual framework for revising the prescribing stage of the medication-use process to include discontinuing medications. This framework has substantial practice and research implications, especially for the clinical care of older persons, who are particularly susceptible to the adverse effects of medications.

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