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Team Approach to Polypharmacy Evaluation and Reduction (TAPER)

Primary care is an under-studied area of health and medicine, yet has the strongest evidence for links with improved population health outcomes. When the burden of treatment outweigh a patient’s capacity to benefit, the negative effects from taking too many drugs can impact the patient’s quality of life and waste healthcare dollars. At the same time, patient preferences and priorities for medications are often not communicated and considered in decisions. Through the Team Approach to Polypharmacy Evaluation and Reduction (TAPER) program, we are assessing a structured and collaborative way to reduce the number of unnecessary medications a patient takes.

The collaborative approach involves the patient, their family doctor, a pharmacist and an online tool (TaperMD), to record information and identify possible inappropriate drugs to “pause and monitor.” TaperMD is the electronic clinical pathway for this process – it is used to record patient priorities and other information and automatically screen the medication list to flag potentially problematic medications. It provides guidance on tapering and monitoring during the “pause and monitor” phase to help the pharmacist and family doctor identify possible inappropriate drugs to ‘pause and monitor’ and record information at each step.

TAPER involves three steps:

  1. Gathering information from the patient to identify their preferences and priorities for treatment and the effects of their medications on them, to clarify the goals of treatment
  2. An appointment with a pharmacist to review these, and begin developing a plan to reduce the dose and/or number of medications
  3. An appointment with the family doctor to adjust the plan and finalize how the medications will be monitored.

In Canada the impact of TAPER is being assessed by having one group of patients receive the program, and a second group receive usual care – this is decided randomly. A total of 360 people from three Canadian provinces who are 70 years of age or older and on 5 or more long-term medications are involved. Health outcomes such as quality of life, mobility, disease and treatment burden, nutrition, pain and sleep are assessed at the start and 6 months later to determine if (and how) outcomes have changed. We are tracking the number and dose of medications. Interviews are being used to help us understand what the intervention is like for all participants.

TAPER is also being adapted and tested in long-term care centres, community pharmacies, and hospitals in Canada and Australia.

Investigators

Co-Investigators
  • Gina Agarwal
  • Alan Cassels
  • Kiska Colwill
  • Lisa Dolovich
  • Barb Farrell
  • Kristina Frizzle
  • Scott Garrison
  • James Gillett
  • Peter Goetzsche
  • Gordon Guyatt
  • Lauren Griffith
  • Joanne Ho (and Co-PI on GeriMedRick-TaperMD)
  • 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
  • Jobin Varughese

Collaborators

AUSTRALIAN TEAM

Principal Investigators

  • Gillian Caughey
  • Rhonda Clifford
  • Deidre Criddle
  • Christopher Etherton-Beer
  • Elizabeth Geelhoed
  • Parker Magin
  • Dee Mangin
  • Vasi Naganathan
  • Amy Page
  • Lynne Parkinson
  • Julie Redfern
  • George Somers

Co-investigator

  • Andrew McLachlan
    • 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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