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Team Approach to Polypharmacy Evaluation and Reduction (TAPER)

Recently awarded over $1 million in grants from the Canadian Institute for Health Research and the Labarge Optimal Aging Initiative, the Team Approach to Polypharmacy Evaluation and Reduction (TAPER) project is working to reduce the harms people experience from taking multiple medications.

Many older adults take multiple regular medications. While the individual drugs may offer benefit, together they may pose problems and the overall combination may cause more harm than good. The higher the number of drugs, the more likely it is that the person will suffer problems. This can have serious consequences for quality of life, including falls, difficulties in thinking, fatigue, poorer mobility and overly complex or confusing medication regimes.

For Dr. Dee Mangin, the Principal Investigator of TAPER and Associate Chair, Research with the Department of Family Medicine, this project continues an important line of research in polypharmacy, drug safety and patient-led health priorities.

The effect of stopping medications in a person on many different medications can be remarkable. Often patients and healthcare professionals are not aware that drugs may be causing side effects such as fatigue or falls until the drugs are paused. Most prescribers will have had the experience of stopping medicines and having the patient experience a remarkable improvement in symptoms and energy.

Over a lifetime, the effects of a medication may change — the benefits may reduce, or disappear. The risk-benefit balance for that person may also change — as people get older, they are more susceptible to side effects and interactions between drugs, and between drugs and diseases.  This problem multiplies for a person on multiple medications. There are very good systems for starting medicines over a person’s lifetime, but there are not sufficient systems for knowing when and how to stop medicines.

TAPER pulls on the strengths of pharmacists, family doctors and patients to test a system to address these issues and test them in a randomized control trial.

The project is designed to support collaboration between patients, their family doctors and a pharmacists. After a pharmacist’s review of their medications, a patient and their family doctor discuss what matter most to them in terms of health and life priorities, and how these relate to the potential benefits and risks of drugs they are taking. Together, they create a plan for reducing or eliminating medications that are unnecessary or may be doing more harm than good, and ensuring the drugs taken align with the patient’s priorities for treatment.

TAPER is supported by a new electronic pathway developed for the project, TAPERMD, which is a system for doctors and pharmacists to securely share information about the process. This system integrates evidence based tools that screen the medication list, flagging potentially harmful medication combinations, and records patient priorities. Its ‘pause and monitor’ clinical pathway guides medication reduction and monitoring.

The TAPER team includes clinicians, researchers and consumers from across Canada. Over the next four years, TAPER will be studying this system at local sites and across Canada. TAPER is also collaborating in an integrated project within Ontario as part of a partnership with Dr. Joanne Ho and the GeriMedRisk project.

Investigators

  • Dee Mangin
  • Gina Agarwal
  • Alan Cassels
  • Kiska Colwill
  • Lisa Dolovich
  • Barb Farrell
  • Kristina Frizzle
  • Scott Garrison
  • James Gillett
  • Peter Goetzsche
  • Lauren Griffith
  • Anne Holbrook
  • Jane Jurcic-Vrataric
  • James McCormack
  • Daria O’Reilly
  • Parminder Raina
  • Julie Richardson
  • Cathy Risdon
  • Mat Savelli
  • Diana Sherifali
  • Henry Siu
  • Lehana Thabane
  • Johanna Trimble

Partner Organizations

    • McMaster University Department of Family Medicine
    • David Braley Health Sciences Centre
    • 100 Main Street West, 6th Floor
    • Hamilton, ON L8P 1H6
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