A team of researchers from CINTESIS – Center for Health Technology and Services Research and the Faculty of Medicine of the University of Porto (FMUP) is building an electronic tool that aims to improve the prescription of medicines to patients over 65, preventing adverse reactions, considered “a public health problem”.
The group’s goal is to create a tool adapted to the Portuguese population, test it on primary care from 2024 and, in the long term, try to integrate it with the information systems used in Primary Health Care, i.e. in health centers and family health units nationwide.
“The electronic medical prescription program has done away with paper, but it’s neither intelligent nor user-friendly because it doesn’t communicate with the doctor, it doesn’t warn, for example, that the dose I’m prescribing isn’t the right one. We can say that the doctor has to know, but the truth is that there is more and more information and it’s impossible to cover everything. We can’t just rely on memory,” explains Luís Monteiro, a researcher at CINTESIS/FMUP.
The aim of this electronic tool, which is already being successfully applied in other countries, is to help doctors detect and discontinue drugs that are no longer needed or that may be causing more harm than good to the patients taking them.
As the main author of this work recalls, “the idea came to me after seeing, when I was still a medical student at FMUP, the bags containing several boxes of medicines, some with the same active ingredient, that elderly people took to their appointments. From my experience as a family doctor, this topic is increasingly important.”
In fact, “elderly patients are more prone to medication-related problems because they are polymedicated”. In Portugal, it is estimated that around 77% of the older population takes more than five medicines at the same time. Barriers to “de-prescribing” in this age group include doctors’ lack of time.
With this tool, doctors will be able to search and access, in a fast and simple way, proposals on which drugs they should discontinue for their patients and how they should do it. The aim is to “save time”.
According to the FMUP professor, “It’s not about adding another window or reducing contact time with the patient. On the contrary. We want to reduce screen time precisely because we free the doctor from the task of reading, and giving suggestions, without replacing the shared decision between the doctor, the patient, and the family.”
In addition to the gains in cost-effectiveness, it has been proven that electronic tools to support “de-prescribing” are “effective in improving the quality and safety of healthcare for the elderly, leading, for example, to a reduction in the number of falls”.
Other strategies to increase the quality and safety of prescriptions are being studied at FMUP, namely the application of instruments that establish a communication channel between family doctors, hospital doctors and pharmacists.
The work has been published in PLOS ONE, and was financed by the Portuguese Foundation for Science and Technology (FCT). Besides Luís Monteiro, other members of the team are the researchers Sofia Baptista, Inês Ribeiro Vaz, Andreia Teixeira and Matilde Monteiro Soares (FMUP/CINTESIS), James McCormack (University British Columbia), in Canada, Cristiano Matos (Polytechnic Institute of Coimbra) and Carlos Martins (CINTESIS).