title: An Ecological Approach to Reducing Potentially Inappropriate Medication Use: Canadian Deprescribing Network.
abstract: Polypharmacy is growing in Canada, along with adverse drug events and drug-related costs. Part of the solution may be deprescribing, the planned and supervised process of dose reduction or stopping of medications that may be causing harm or are no longer providing benefit. Deprescribing can be a complex process, involving the intersection of patients, health care providers, and organizational and policy factors serving as enablers or barriers. This article describes the justification, theoretical foundation, and process for developing a Canadian Deprescribing Network (CaDeN), a network of individuals, organizations, and decision-makers committed to promoting the appropriate use of medications and non-pharmacological approaches to care, especially among older people in Canada. CaDeN will deploy multiple levels of action across multiple stakeholder groups simultaneously in an ecological approach to health system change. CaDeN proposes a unique model that might be applied both in national settings and for different transformational challenges in health care.
authors.affiliation: Faculty of Medicine and Faculty of Pharmacy,Université de Montréal.
authors.forename: Cara
authors.initials: C
authors.lastname: Tannenbaum
authors.affiliation: Bruyère Research Institute,Ottawa.
authors.forename: Barbara
authors.initials: B
authors.lastname: Farrell
authors.affiliation: Institute for Health System Solutions and Virtual Care,Women's College Hospital,Toronto.
authors.forename: James
authors.initials: J
authors.lastname: Shaw
authors.affiliation: School of Population and Public Health,University of British Columbia.
authors.forename: Steve
authors.initials: S
authors.lastname: Morgan
authors.affiliation: Patients for Patient Safety Canada,Canadian Patient Safety Institute,Edmonton.
authors.forename: Johanna
authors.initials: J
authors.lastname: Trimble
authors.affiliation: Interdisciplinary Studies Graduate Program/School of Population and Public Health,University of British Columbia.
authors.forename: Jane
authors.initials: J
authors.lastname: Currie
authors.affiliation: Institut universitaire de gériatrie de Montréal.
authors.forename: Justin
authors.initials: J
authors.lastname: Turner
authors.affiliation: Women's College Hospital,Toronto.
authors.forename: Paula
authors.initials: P
authors.lastname: Rochon
authors.affiliation: Alberta Health Services,Calgary.
authors.forename: James
authors.initials: J
authors.lastname: Silvius
mesh_terms: D000368:Aged; D002170:Canada; D003299:Cooperative Behavior; D000069340:Deprescriptions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control; D005260:Female; D018166:Health Care Reform / Q000191:economics / Q000379:methods; D006801:Humans; D008297:Male; D019338:Polypharmacy; D016730:Program Development / Q000379:methods*
keywords: aging; deprescribing; dépréscription; engagement du patient(s); health policy; inappropriate medications; médicaments inappropriés; patient engagement; politique de la santé; vieillissement