Project 452912

Prescribing cascades occur when a drug is prescribed, a provider misinterprets the side effect as a new medical condition, and a second drug is prescribed to treat that condition. Based on our research to date, we now KNOW believe that there are more than 100 prescribing cascades and many more to be identified. While we know that prescribing cascades occur, health care providers lack an inventory of these cascades that is easy to use, and context-specific tools relevant to their circumstances to inform their prescribing and deprescribing decisions. Much remains unknown in order to create a tool that can be applied to prevent prescribing cascades from occurring, detect them when they have occurred, and to use this information as appropriate to reverse them. Our research will address these gaps in knowledge. We will analyze large population-level data in order to develop a prioritized list of prescribing cascades for deprescribing among older adults, with a specific focus on setting of care, sex and age. For the prioritized list of prescribing cascades, we will use healthcare datasets to help define the circumstances the led to their occurrence. We will identify who is prescribing and receiving these drugs, when they are being prescribed, and how long the prescription has been in place. We will take what we have learned and, using a collaborative interdisciplinary approach, create a tool to enhance an internationally set of inappropriate prescribing guidelines known as STOPP/START, one of the world's most widely used inappropriate prescribing criteria designed to inform deprescribing (i.e., decreasing doses or stopping medications). Our research evidence will be shared widely, and will include activities intended for researchers, as well as those designed to educate patients, caregiver and health providers to prevent prescribing cascades and their complications.