A variety of causes can lead to a patient accumulating multiple drug treatments, or to a treatment being extended indefinitely. In some cases, this is justified, for example in a patient with several conditions that would most certainly worsen if left untreated.

In other patients, such accumulation is less justified. Treatments may be continued simply out of habit, or because nobody has paused to consider whether they are still useful. Healthcare professionals may be unaware that a treatment's harm-benefit balance is no longer favourable, because they have not kept their knowledge up to date. There may be multiple prescribers who do not consult each other, or cannot be contacted by pharmacists who may wish to raise concerns over the consequences for the patient of dispensing some of the prescribed drugs. And some treatments are prescribed under the influence of pharmaceutical marketing or, more insidiously, social pressure.

Patients can also be reluctant to let go of the medications they have become “hooked” on, even when informed that the benefits may be modest and the harms very real. And both patients and healthcare professionals often find it hard to shake off the idea that every disease can be treated and every symptom relieved, by simply adding more drugs. So, with the best of intentions, some healthcare professionals pile on the medications, to reassure the patient, and themselves to some extent, overlooking the risks. Sometimes because it seems easiest.

Striving for more moderate drug use is neither an end in itself nor a moral value. There are many reasons for moderate use of medicines. First and foremost, to reduce the risk of adverse effects and drug interactions. But also to use drugs for what they are: just one of several therapeutic options, not the answer to everything.

The pursuit of moderate use of medicines is a practical approach to apply every day, with every patient. It requires taking the time to determine healthcare priorities with the patient, abandoning the urge to medicate every problem, examining each patient's treatments systematically, with a view to keeping only those treatments that are justified and appropriate to the situation, avoiding those that are unnecessary or carry disproportionate risks, and sometimes suggesting that the patient stop taking certain drugs. It also requires consultation with other healthcare professionals or caregivers involved in the patient's care.

With its annual review of drugs to avoid, freely available online > HERE, Prescrire provides information that is useful for implementing a strategy of moderate use of medicines. By pointing out drugs that should be avoided in the first place and suggesting alternatives.

The pursuit of moderation, especially moderate use of medicines, is a crucial component of providing quality care.

©Prescrire 1 September 2022

Source: "Moderate use of medicines" Prescrire International 2022; 31 (240): 199. Free

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