Dr. Carole Goodine on Polypharmacy, Deprescribing and the Need for Pharmacy-Related Policy Changes

AUTHOR(S) & CREDENTIALS:  Dr. Carole Goodine, Clinical Pharmacy Manager at Dr. Everett Chalmers Hospital, and Karolina Jalowska, Digital Media Coordinator at the APPTA hub and AGE-WELL NCE

AFFILIATED INSTITUTION(S): AGE-WELL National Innovation Hub: APPTA

ACKNOWLEDGEMENTS: Candice Pollack, Executive Director at the APPTA hub

Can you tell me a bit about yourself and your role as a Clinical Pharmacy Manager?

I’ve been a practising pharmacist for over 30 years. Currently, I’m the Clinical Pharmacy Manager at Dr. Everett Chalmers Hospital in Fredericton, New Brunswick. Over the years, I’ve had a lot of opportunities to practise in different areas of pharmacy so I bring a unique perspective to my work. When I was working with seniors and long-term care facilities for instance, I was able to experience the community side to pharmacy and now at the hospital, I’m working on the acute care side.

There is no typical day for a clinical pharmacy manager. My time is divided between directly providing patient care, project planning, human resources, sitting on a number of committees, and more. Part of my responsibility is to maintain a clinical practice and the area I’ve chosen is Healthy Aging, so supporting the Geriatric and Rehabilitation unit at the hospital. I’ve been working with the Healthy Aging program for almost 18 years now. I’m really passionate about working with older adults, helping them understand the role they play in their health care, and helping them find the best way to do that. It’s really rewarding to me.

What pharmacy-related project are you working on?

I’m a part of a pharmacy app project, which is partially funded by AGE-WELL. The application is called MedReviewRX, which is an app designed for health care providers like physicians, pharmacists and nursing staff to help them with deprescribing medications for their patients. Some patients take many medications and over time, this can actually cause certain, unwanted symptoms to arise because the way that medications interact with our bodies over time can change. By collecting data on a patient’s medical history, the app provides the end-users with a deprescribing opportunity report. This report provides them with the reason why certain medications that a patient is taking may be problematic and it also provides guidelines on how to deprescribe them safely. We’re preparing to pilot the app at five nursing homes in New Brunswick to monitor how it impacts the way medications are prescribed in the nursing homes, what some of the barriers and challenges might be, and what we need to do to improve the product. We hope once the pandemic settles down, we’ll be able to implement the project.

Why should older adults be aware of polypharmacy and the potential benefits of deprescribing?

Polypharmacy can seem like a complicated word but it just means “lots of medications” or taking lots of medications. There are, of course, benefits to taking medications but there can also be potential harms. People need to be aware that the way medications work may change as we get older and it’s important to talk to your physicians, pharmacists and health care providers that if there’s a change in the way you feel, you shouldn’t rule out your medications just because you’ve been taking it for a long time. So, sometimes, deprescribing safely, with the help of you your health care practitioner, can be beneficial and help alleviate symptoms that may have arisen as you’ve aged and taken the medications for a significant period of time.

Are there any policy changes that you’d like to see when it comes to pharmacy?

Firstly, I would like to see pharmacists receive more reimbursements for their services. Community pharmacists receive reimbursements for dispensing prescriptions, which means that the extra advice and monitoring they provide for patients, that impact their care, is not usually reimbursable. This makes it difficult because many of them are providing excellent care by going above and beyond and are not compensated for it.

I also think there’s a real need to see more pharmacists on primary health care teams. Most of the physicians I work with really value the perspective pharmacists bring and since medications and prescriptions are becoming more complicated and people are living longer and therefore, are on more medications for longer, I think it’s really important to have that perspective because it is valuable for patients’ overall health and wellbeing. As a pharmacist, I know we make a difference and I’d love to see policy changes to support and provide opportunities for pharmacists to be more involved.