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Deprescribing: A Growing Trend — August 2017

Deprescribing: A Growing Trend — August 2017


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What Was Good Then May Not Be Now

It is becoming more and more common for people to take five or more medications. The more medications a person takes, the greater their risk for negative health outcomes, such as reduced quality of life, increased side effects, drug interactions, physical or mental impairment, falls, addiction, hospitalization or even, death. The use of some medications, especially as people age or become sicker, can do more harm than good. There is also greater risk of taking them incorrectly—the more medications, the more confusion.

Taking five medications or more is called polypharmacy, which increased nearly 63% among people over 65 years between 1999 and 2012 according to a Harvard study reported in JAMA (Journal of American Medical Association) in November 2015. Given the concerns about polypharmacy, medical professionals are taking a growing interest in carefully guiding their patients through a process of deprescribing.

Easy to Start, Hard to Stop

Clinical guidelines for how and when to start a medication are readily available to clinicians. Historically, these guidelines have not included instructions on how to stop medications. This may be one of the reasons that the number of people who take 5 or more medications is on the rise. It may be possible to shorten your medication list through a careful process of deprescribing developed and managed closely by your provider.

Deprescribing refers to a careful medication review and the process of reducing or stopping medication(s) that no longer provide benefit or may be causing harm. Besides reducing some of the above risks, deprescribing can help patients save money and become more compliant with taking their medications as prescribed.

“Frequently, a medication is started to see whether it will help with certain symptoms—almost like a diagnostic test—but then the medication is never stopped,” said clinical scientist Barbara Farrell, PharmD, as reported by Medscape. Farrell is the co-developer of a website (deprescribing.org) that strives to raise awareness about deprescribing and is cofounder of the Canadian Deprescribing Network. She and her colleagues have developed guidelines for deprescribing among the elderly, who tend to have more medical conditions, and as a result, tend to take more medications. The guidelines apply to four classes of drugs and they are developing additional guidelines for other commonly prescribed medications. While Farrell’s work is focused on the elderly, it can be useful for providers helping their patients of any age arrive at safe and appropriate medication regimes.

A Case In Point

Judith* has diabetes, vascular disease, high blood pressure and high cholesterol. She enrolled in KnovaSolutions when her doctor retired and needed help finding a new one. When Judith said she sometimes felt dizzy, was often fatigued, and was tired of taking so many pills, her KnovaSolutions nurse and pharmacist performed a medication review and discussed their concerns with her. Judith admitted she couldn’t remember the reasons for starting several of her medications. Along with her list of 17 medications (and a few supplements), Judith took a list of questions that she and her nurse had prepared to her first appointment with the new provider. The new doctor agreed that change would be beneficial.

Judith’s story is a good example of “what was good then may not be now.” After her doctor’s review and a transition period, Judith stopped taking five medications, reduced the dose of two, substituted one medication with an over-the-counter (OTC) option, and stopped one supplement that her doctor felt would be safer not to take. Judith told her KnovaSolutions nurse, “The oddest thing that I discovered from my desprescribing process is that one of the medications I stopped was prescribed to treat the side effects caused by one of the other drugs I stopped. I’m so glad you and my doctor helped me!”

“The oddest thing that I discovered from my deprescribing process is that one of the medications I stopped was prescribed to treat the side effects caused by one of the other drugs I stopped.”

—Judith*

*Name changed for privacy

 

A Careful Process

The process of deprescribing should always be closely monitored by a provider who knows your medical history and conditions well. Deciding what to change is complicated, and depends upon your current health status, symptoms and personal preferences. Here are some things to consider:

  • OTC medications, nutritional supplements, vitamins and herbal remedies can sometimes interact with prescription medications and/or cause side effects that are mistaken as new symptoms. Therefore, it is important to give your provider a complete list of your medicines and supplements. Also, it is important to be honest if you do not take prescribed medications as instructed (for any reason, such as they are too expensive, you never started them to begin with, you don’t like how it makes you feel, etc.).
  • Deciding where to start is critical. You don’t want to change too many things at once because it will be hard to pinpoint what is working and what is not. Your provider will help establish what medications should remain stable and which may be unnecessary. S/he’ll discuss what may need to be slowly tapered before stopping or reducing, replaced with a safer drug, or whether one drug can treat multiple conditions, etc.
  • Do you feel confident that both you and your provider will carefully monitor the transition period? While the goal is to reduce or stop medications that are no longer helping or are causing harm, making changes can disrupt a delicate balance. Keeping in close contact with your provider during this time can help avoid larger problems. Ask about how to handle any potential side effects, symptoms or questions.
  • Your KnovaSolutions clinician can help you better understand your medications and perform a medication review. The review can identify potential adverse drug interactions, duplicate therapies (when two or more medications are used to treat the same condition), and/or safer or cheaper options. You may also learn about alternative therapies that might reduce your reliance on medications. With the results of your review, you will be better prepared to discuss deprescribing with your provider.

Call KnovaSolutions at 800/355-0885, Monday – Friday, 8 am – 5 pm, Mountain Time.

Click here to view/download the full newsletter. We encourage you to leave a comment or question below and a KnovaSolutions nurse or pharmacist will reply.

The information contained in this newsletter is for general, educational purposes. It should not be considered a replacement for consultation with your healthcare provider.  If you have concerns about your health, please contact your healthcare provider.


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Preventing Surprise Medical Bills — July 2017

Preventing Surprise Medical Bills — July 2017


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What to Do If You Get One

An unexpected medical bill can be a very unpleasant surprise. It is a bill for a medical service that you did not expect to receive because you thought your insurance would cover it. Surprise bills are becoming more common as our healthcare system becomes more complex and insurance companies reduce the number of providers in their network or exclude coverage for out-of-network services.

The best way to avoid surprise medical bills is to prevent them. It’s not always possible, but there are ways to minimize the risk.

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The Opioid Epidemic — May 2017

The Opioid Epidemic — May 2017


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Taking Ownership and Being Part of the Solution

You’ve heard the news reports about the dangers of opioid medications such as codeine, morphine, methadone, fentanyl, hydrocodone and oxycodone. While opioids can be an appropriate and effective treatment for pain, the U.S. has the highest rates of opioid use in the world. According to the National Institute on Drug Abuse, about 80% of the world’s prescribed opioids are used in the U.S. Great risk comes with such widespread use. From 2010 to 2015, more than 500,000 people died from opioid overdoses.

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Shared Healthcare Decision-Making — April 2017

Shared Healthcare Decision-Making — April 2017


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How to Improve Outcomes and Decrease Costs

Numerous studies performed in the last 10 years suggest that patients who actively participate in making healthcare decisions with their doctors report greater satisfaction with their care, better outcomes and lower costs. For example, a study reported in Health Affairs of 33,163 patients at a large healthcare facility in Minnesota showed that better informed patients cost less to treat. In the first year of the study, knowledgeable patients had 8% lower treatment costs, and, in the first half of the following year, 21% lower costs, than less involved patients.

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How Short Are Your Doctor Visits? — March 2017

How Short Are Your Doctor Visits? — March 2017


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Getting the Most Out of Your Appointments

Depending upon which source you read, the average length of time a doctor spends with each patient ranges from 5 minutes to 23 minutes. That’s not a lot of time to discuss your health history, medications, symptoms and concerns — much less talk about complicated information or a new serious condition. So how can you get what you need — and deserve —during each doctor visit? All arrows point first to having a primary care provider (PCP) with whom you develop a trusting relationship.

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Medication Errors at Home  — February 2017

Medication Errors at Home — February 2017


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How to Reduce Risk and Prevent Mistakes

Prescription and over-the-counter medications provide major health improvements for people, but they also pose potential risks. Adverse drug events — harm as a result of exposure to a medication — are associated with hundreds of thousands of emergency room visits and hospitalizations each year.

Home medication errors happen all too often. In a study at the New York University School of Medicine-Bellevue Hospital, it was found that one out of five parents who measured liquid medication for their children gave them twice the directed dose. Also, nearly all the parents measured the dose incorrectly to some degree.

Confusing ear drops and eye drops, chewing non-chewable pills, and splitting pills not designed to be split are other types of errors that happen at home.

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Wasteful Medical Spending — January 2017

Wasteful Medical Spending — January 2017


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Is There Anything You Can Do?

It is widely documented that the U.S. spends more on healthcare per person than any other country, yet much research shows that Americans are not healthier as a result. Wasteful spending accounts for 30 percent of the $3.2 trillion spent on healthcare each year. That’s $9.6 billion of waste per year! While this may seem like a challenge too large, there are ways to do your part to reduce wasteful spending.

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All in a Night’s Sleep — December 2016


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Recognizing and Treating Insomnia

Does it take more than 30 minutes to fall asleep? Do you wake more than 3 times a night? Do you get less than 6 hours of sleep? If you answered yes to these questions, you may suffer from insomnia.

Having trouble sleeping can happen to anyone but it is more common among women, middle-aged or older adults, shift workers, and those with medical conditions.

Insomnia can be acute or chronic. Lasting up to a month, acute insomnia is usually related to a stressful situation, such as an upcoming presentation or the start of a new job. Once the presentation has been given and the new job becomes more familiar, the insomnia often resolves. Chronic insomnia, occurring more than 3 nights a week for at least 3 months, can be caused by:

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Prediabetes Diagnosis is a ‘Gift’ — November 2016


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Taking Measures to Reduce Risk for Diabetes

More than 29 million Americans live with diabetes — a serious condition in which blood glucose (sugar in the blood) builds to dangerously high levels. What’s more, another 86 million live with prediabetes, that is, have strong risk factors for developing type 2 diabetes. The Center for Disease Control states that 90% of people with prediabetes don’t know they have it!

“A diagnosis of prediabetes is a gift and a wake-up call,” says Marilyn Novosel, MPH, RN, CDE, the Certified Diabetes Educator for KnovaSolutions. “Learning that you have risk factors for developing diabetes is an opportunity to do something about it sooner rather than later.” She adds that making lifestyle changes can slow the progress, reduce the possibility of long-term complications, and for some, return blood sugar levels to normal.
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Flu Season Starts Now — October 2016


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Who Should Have Flu and Pneumonia Shots?

Getting the flu can leave you feeling lousy and unable to attend school or work for as long as 2 weeks, and longer if complications develop. Further, having the flu can put you at higher risk for developing pneumonia and other serious conditions. According to the Centers for Disease Control (CDC), getting the flu shot is “the first and best way to protect yourself and your family.”

The more people who get vaccinated, the more people will be protected from the flu. In 2010, the CDC recommended that everyone over the age of 6 months get a flu shot every year unless they have a severe, life-threatening allergy to the flu vaccine or its ingredients. People who should talk with their provider before getting the flu shot include those:
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Proton Pump Inhibitors — September 2016


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Understand the Potential Risk of Long-Term Use

Stomach acids work miracles to digest the foods we eat. But when there is too much acid, and in the wrong place, it can cause heartburn and reflux (when acid moves from the stomach back up the esophagus). It can also contribute to the development of ulcers (holes in the protective lining of the stomach, small intestine or esophagus). These conditions can cause very uncomfortable burning sensations in the chest, stomach, and even, throat. Fortunately, a variety of treatment options — over-the-counter (OTC) and prescription medications and lifestyle changes — can offer relief.

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Does Alcohol Trigger AFib? — August 2016


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Atrial Fibrillation: A Growing Concern

Atrial fibrillation (AFib or AF) is sometimes called the quivering heart. It is the most common type of irregular heartbeat, or arrhythmia. Fibrillation refers to the heart contracting very fast and irregularly.

To understand AF, it helps to think of the heart as the body’s electrical system. Each time our heart beats, an electrical signal is sent from the top of the heart to the bottom, causing it to contract and pump blood to the lungs and the rest of the body.

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Activity and Fitness Trackers: Studies Show They Get People Moving — July 2016

Activity and Fitness Trackers: Studies Show They Get People Moving — July 2016


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Have you noticed people wearing stylish wrist ware or other devices, and talking about how many steps they’ve taken? Activity and fitness trackers like FitBit, Garmin, Mi Band, Jawbones and pedometers represent a burgeoning business projected to reach $19 billion by 2018. These devices are used to monitor and measure physical activity, heart rate, sleep patterns and more. A review of studies published in the Journal of the American Medical Association concluded that use of a pedometer — a device that records steps taken and distance —is associated with significant increases in physical activity and decreases in body mass index and blood pressure.

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Avoiding the Bulge After 50 — June 2016


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How to Maintain a Healthy Weight

As we age, it becomes harder to drop pounds and maintain a healthy weight. That’s because our metabolism slows down, we burn fewer calories and we lose lean muscle mass. It can be discouraging and for some, dangerous. But there are ways to maintain a healthy weight after 50, and it’s never too soon — or too late — to start.

Our metabolism slows as we age due to falling hormone levels. As testosterone levels drop, men tend to add body fat to their abdominal area. As estrogen levels fall, women often see a shifting of weight from their hips and buttocks to their mid-section. Our bodies also begin losing lean muscle mass starting around age 30, which may be a result of less active lifestyles. Being less active usually leads to burning fewer calories, and that often increases weight and fat mass, and decreases muscle mass.

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New CDC Guidelines for Opioid Use — May 2016

New CDC Guidelines for Opioid Use — May 2016


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Safe Use Saves Lives and Reduces Complications

Opioids, or narcotic medications, are powerful pain killers. They can be an appropriate and effective part of managing pain, but the overuse and misuse of these prescription drugs has become a public health crisis. Since 1999, the use of opioids has quadrupled and more than 165,000 people have died from their use. The Center for Disease Control (CDC) estimates that 40 Americans die from opioid overdoses every day. To improve the safety of opioids, the CDC released new guidelines in March for how these medications should be prescribed.

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Telehealth: Remote Healthcare — April 2016

Telehealth: Remote Healthcare — April 2016


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Transforming Modern Medical Care

While healthcare has traditionally been delivered in a doctor’s office, hospital or outpatient clinic, technology continues to transform modern medical care. Telehealth is a broad term to describe remote healthcare services using video-conferencing equipment, mobile devices, internet access, remote monitoring devices and other tools. Telehealth promises to increase the contact between a patient and his or her providers, especially for those who live in rural areas or for whom travel to a medical facility is difficult (or even for busy working parents).

Because it can save travel time and expense for providers and patients, telehealth can improve the chances that people will receive preventive care and better management of chronic conditions. Telehealth can facilitate specialist consultations, whether the provider is across the state or across the world.

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The Shingles Vaccine: Your Risk for Shingles As You Age — March 2016

The Shingles Vaccine: Your Risk for Shingles As You Age — March 2016


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Shingles is a viral infection caused by varicella zoster, the same virus that causes chicken pox. Anyone who has had chicken pox can get shingles since the virus stays inactive in the body’s nerve tissue and can re-emerge later. The Centers for Disease Control (CDC) estimates that about 1 million Americans get shingles each year, and that half of all shingles cases occur in people 60 years or older.

While anyone with a history of chickenpox can get shingles (even children), it is most common among people over 50 and those with weakened immune systems due to cancer, HIV/AIDS and other conditions. Taking certain medications, such as chemotherapy for cancer, steroids, and those drugs used to prevent rejection of transplanted organs, can increase the risk of developing shingles. Asthma is under study as a potential risk factor for developing shingles.

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Screening for Cancer. Breast and Colorectal Cancer Screening — February 2016

Screening for Cancer. Breast and Colorectal Cancer Screening — February 2016


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Breast and Colorectal Cancer Screening

The American Cancer Society (ACS) estimates there will be nearly 1.7 million new cancer diagnoses, and nearly 600,000 cancer deaths, in 2016. While there are several risk factors for cancer you can’t control (gender, race, age, family history), there are lifestyle actions that have been associated with the prevention of cancer. Experts recommend living a healthy lifestyle, including not smoking, eating a well-balanced diet (more vegetables, fruits and whole grains/less processed food and red meat), protecting against sunburn, exercising regularly, keeping a healthy work/family balance, and having preventive screening tests that are right for you. Identifying cancer at its earlier stages increases the possibility of successful treatment.

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Know Your Out-of-Pocket Costs — January 2016

Know Your Out-of-Pocket Costs — January 2016


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Know Your Out-of-Pocket Costs
With Your High-Deductible Health Plan.

A growing number of people are covered by high-deductible health plans (HDHPs). As the name implies, these plans have higher deductibles than traditional insurance plans in exchange for lower monthly premiums. HDHPs are designed to make health insurance more affordable and to provide for coverage for catastrophic illness. The deductible amount specified by the insurance plan is the amount that the insured person must pay out-of-pocket until eligible healthcare expenses are covered in a given year.

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The Problem With Antibiotics — December 2015

The Problem With Antibiotics — December 2015


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Too Much of a Good Thing Puts Us at Risk

When penicillin, the first antibiotic, was introduced in the 1940s, it began an important era of treating bacterial infections, preventing the spread of illness and reducing serious complications. Penicillin and the many other antibiotics that have been developed since have played a very important public health role throughout the world. They have successfully treated all kinds of infections caused by bacteria, such as urinary tract infections, strep throat, pneumonia, some types of ear infections, scarlet fever, Lyme disease, and skin infections.
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Special Edition: All About Health Scores — November 2015

Special Edition: All About Health Scores — November 2015


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Your KnovaSolutions Health Score

What it is and how you can use it.

We’re all defined by numbers. Social Security number, age, height, weight, bank account, credit score. As a KnovaSolutions member, you also have a health score.

What’s that good for? Well, just as you can clean up your credit score to improve your finances, you can also work on the things that go into your health score and blaze a trail to better health.

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Living With Chronic Pain: A Focus on Inflammatory and Compressive Pain — November 2015

Living With Chronic Pain: A Focus on Inflammatory and Compressive Pain — November 2015


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Chronic Pain Series

This is the last in a three-part series on chronic pain. Click here to see the first part, Chronic Pain: An Overview.  Click here for part two, Two Types of Chronic Pain: Neuropathic and Musculoskeletal Examined.

 

Millions grapple with chronic pain every day. While everyone’s pain is unique, chronic pain sufferers agree that it can affect your ability to sleep, work, perform routine activities, and enjoy life. Developing a pain management strategy often involves a process of trial and error, starting with understanding the type and source of the pain. This month KnovaSolutions focuses on inflammatory and compressive pain.
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Two Types of Chronic Pain: Neuropathic and Musculoskeletal Examined–October 2015

Two Types of Chronic Pain: Neuropathic and Musculoskeletal Examined–October 2015


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Chronic Pain Series

This is the second in a three-part series on chronic pain. Click here to see the first part, Chronic Pain: An Overview. Click here for November’s focus on inflammatory pain and mechanical/compressive pain.

If you have chronic pain, you’ve probably scored it from 1 to 10 on the happy-sad face continuum. Is your pain mild, moderate or excruciating? Is it inconvenient or incapacitating? While not all pain can be cured, most pain can be managed so it interferes less with daily life. Read on to learn more about neuropathic and musculoskeletal pain.

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