MEDSTOPPER

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Starting medications is like the bliss of marriage and stopping them is like the agony of divorce. - Doug Danforth

Frequently Asked Questions


HOW TO USE MEDSTOPPER
1. Why do we need a tool to help stop medications?
2. How did you determine the rankings of each medication?
3. Do I have to follow the advice of MedStopper?
4. What do you consider inappropriate polypharmacy? (ie: too many drugs)
5. What does MedStopper do that other polypharmacy tools don't?
6. Why do you have a "frail elderly" button?
More Questions?

Since MedStopper is a work in progress, we welcome any and all suggestions, criticisms and other feedback to make this tool better and more useful.

CONTACT

HOW TO USE MEDSTOPPER


1) Indicate if the patient would be considered as frail elderly. This adjusts the "May cause harm" ranking category. The frail elderly status can be determined by using the Edmonton Frail Scale.

2) Type the first few letters of either the generic or brand name of a medication.

3) A list of medications will be presented in the table below.

4) Each medication may have a number of different indications. Select the specific indication for each medication. This selection will impact the rating of the medication under the "May improve symptoms" or "May reduce future illness" ranking categories. After choosing the indication click ADD and the medication will be added to the MedStopper plan.

5) There are three rating levels under each of the ranking categories

a) Unhappy Face

b) Neutral Face

c) Happy Face

These three rankings are added up to create the order of the stopping priority.

If "other" is chosen as the indication the ranking will be blank as we can only provide a ranking for specific indications. By default an "other" medication will be placed at the bottom of the stopping priority list.

If "unknown" is chosen as the indication both "May improve symptoms" or "May reduce future illness" ranking categories will be indicated as unhappy faces because if the indication for a drug is unknown this is of concern. Therefore, "unknown" indication medications will be ranked at the top of the stopping priority list.

6) Continue to populate the MedStopper plan with all the patient's medications.

7) The MedStopper plan includes the following

a) medications can be arranged by either stopping priority or by medical condition

b) for some medications/indications, just below the faces, there are CALC and NNT links for more information. The CALC links to on-line calculators that help you make individual assessments of risks and benefits. The NNT takes you to the relevant NNT information provided by thennt.com

c) a suggested tapering approach

d) possible symptoms to assess during the tapering process

e) if the medication is listed in either the Beers or STOPP criteria, click the details button and the specific criteria form these tools will be provided in a popup

Why do we need a tool to help stop medications?


Often patients will see multiple prescribers, have occasional stints in the hospital and see a number of specialists. Each visit can result in new prescriptions and those prescriptions can add up quickly. Patients and clinicians need some help in deciding which drugs are truly helping, which could be reduced or tapered, or which ones could be stopped altogether because they are no longer needed or are causing side effects.

How did you determine the rankings for each medication?


Our team of experts assessed approximately 400 individual medications in roughly 100 medication categories (eg statins, SSRIs, ACE inhibitors etc). Since individual medications can be used for a number of different indications (blood pressure, heart failure, depression, chronic pain etc) each medication category was expanded to include the typical indications associated with each medication. The final MedStopper database should include the majority of medications/indications used in family practice.

For each medication category/indication, we asked our experts, who have experience and knowledge in the area of therapeutics and polypharmacy, to provide a ranking of each of the approximately 350 medication categories/indications based on three criteria - potential for symptom control, potential for long term benefit, and potential for harm. For each one of these criteria we asked our experts to use their practical experience and knowledge of the evidence to rank them on a scale of 1 to 3. The final ranking used in the database was one determined by consensus. We also asked our experts, again based on their experience and knowledge of the evidence, to decide if one was to stop a particular medication whether it could be done abruptly or if a tapering schedule should be used. If tapering was recommended an approach to tapering and a list of specific signs and symptoms to monitor were also developed.

Do I have to follow the advice of MedStopper?


Absolutely not. This web-based tool is just a guide to help you think about the balance of benefit and harm from medications. How you choose to use that information is entirely up to you.

What do you consider inappropriate polypharmacy? (ie: too many drugs)


For the purposes of this project, inappropriate polypharmacy in an individual patient is considered as
a) someone taking a medication for a symptom which is not providing a clinically important effect or is being used at a dose larger than is required to achieve that effect, or;
b) taking a medication to reduce the risk of future illness which, if one was fully informed about the benefits and harms one would not take.

What does MedStopper do that other polypharmacy tools don't?


While there are a number of resources that help clinicians identify problem medications (BEERS, DBI, STOPP), these resources fail to provide specific medication benefit/harm information or guidance as to how to stop particular medications. We felt there was need for a resource that could provide a synopsis of the value of a specific medication's benefit/harm, rank them in terms of which might be least helpful to most helpful and provide some brief suggestions on how to stop or reduce the dose of a specific medication.

Why do you have a "frail elderly" button?


This is because 'frail' people are likely more sensitive to medications, especially multiple medications, than younger, healthier people. The consequences of inappropriate prescribing can be much more dire in older people, and the possibility that an adverse event can be caused by medication must always be considered. When you click on MedStopper's "Frail Elderly" button each harm category becomes one more level worse. Which is to say, for medications that might appear as neutral in terms of benefit or harm in a non frail elder, these can become decidedly more complicated for the frail elder. For more about the frail elderly and medication use, try this link.