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TAPER Researchers Narrow-in on Better Medication Use

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 lessen the harms people experience from taking multiple medications.

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.

“We have very good systems for starting medicines over a person’s lifetime,” says Dr. Mangin, “but we don’t have good systems for knowing when and how to stop those same drugs.”

Many older adults take multiple regular medications. While the individual drugs may offer benefits, together they may pose problems — potentially causing more harm than good.

However, Dr. Mangin says “the effect of stopping medications with someone on many different drugs can be remarkable. Often we are not aware the medications may be causing side effects such as fatigue or falls, until we pause them.”

As a randomized control trial, TAPER is testing a system that pulls on the strengths of pharmacists, family doctors and patients to address these issues. “The patient is the expert in what matters to them and the effects of medicines on them. The pharmacist and doctor are the experts in how the treatments might be helpful or harmful.”

Following a pharmacist’s review of their medications, the patient and their family doctor discuss how a patient’s health and life priorities relate to the potential benefits and risks of the drugs they are taking. Together, they create a plan for reducing or eliminating medications that are either unnecessary or may be doing more harm than good.

TAPER is supported by a new online system called TAPERMD where doctors and pharmacists can securely share information about the process. TAPERMD provides evidence-based tools to record patient priorities and screen medication lists — flagging potentially harmful combinations. The system follows a ‘pause and monitor’ clinical pathway for safe 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 in Hamilton and across Canada. TAPER is also collaborating in an integrated project in Ontario as part of a partnership with Dr. Joanne Ho and the GeriMedRisk project.

McMaster University Department of Family MedicineMichael G. DeGroote School of Medicine