Discontinuing medications: a novel approach for revising the prescribing stage of the medication-use process

Abstract

Thousands of Americans are injured or die each year from adverse drug reactions, many of which are preventable. The burden of harm conveyed by the use of medications is a significant public health problem, and therefore, improving the medication-use process is a priority. Recent and ongoing efforts to improve the medication-use process have focused primarily on improving medication prescribing, and not much emphasis has been put on improving medication discontinuation. A formalized approach for rationally discontinuing medications is a necessary antecedent to improving medication safety and improving the nation's quality of care. This article proposes a conceptual framework for revising the prescribing stage of the medication-use process to include discontinuing medications. This framework has substantial practice and research implications, especially for the clinical care of older persons, who are particularly susceptible to the adverse effects of medications.

Figure 1

The medication-use process, illustrating the prescribing stage revised to include discontinuing medications. See text for listing of indications for either initiating or changing or for discontinuing medications. Numbers denote the steps in the discontinuation process.