Ep29: Drug Interactions and Deprescribing

09/26/17 • 28 min

Adverse drug events cause about five per cent of admissions to a public hospital, although some studies suggest the figure could be as high as 15 per cent. That makes at least half a million patients in Australia and 55,000 in New Zealand every year.

Drug-drug interactions make up about a fifth of these adverse events. They have become more frequent over the decades, as more medications reach the market. More than half of people over the age of 75 are on five or more prescriptions—a state referred to as polypharmacy.

This episode examines some of the systems that have led to current rates of polypharmacy, and some strategies for deprescribing. We also discuss Professor Richard Day's recent review of drug interactions from the Internal Medicine Journal, and highlight the combinations physicians should be most concerned about.

Guests
Professor Richard Day FRACP (St Vincent's Hospital, UNSW)
Professor Sarah Hilmer FRACP (Royal North Shore Hospital, University of Sydney).

Production
Produced by Mic Cavazzini. Music courtesy of Daddy Scrabble ('Flying Pea', 'Cherry Blossom'), Doctor Turtle ('Manly Nunn Steps Out'), and Scott Holmes ('Chasing Shadows'). Photo by iStock. The production manager was Anne Fredrickson.
Editorial feedback for this episode was provided by RACP Fellows Dr Paul Jauncey, Dr Marion Leighton, Dr Rebecca Grainger, Dr Alan Ngo, Dr Phillipa Wormald and Dr Michael Herd.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

Guests
Professor Richard Day FRACP (St Vincent's Hospital, UNSW)
Professor Sarah Hilmer FRACP (Royal North Shore Hospital, University of Sydney).

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

Previous Episode

Ep28: Transitions to Fellowship

The transition from trainee to consultant marks an exciting and daunting step in a clinician's career. Suddenly you take on responsibility for everyone on the ward—both patients and other staff. And while clinical skills have been hammered in over years of training, the 'hidden curriculum' can be harder to pick up. The College has recently published How to Thrive as a New Consultant, a handbook to help navigate this period with confidence.

For today's show, guest producer Zacha Rosen spoke to four physicians who look back on their transitions, from six months on to nine years on. They capture the experience of striking out as a leader, manager and mentor to others. At the same time, one doesn't need to have all the answers. Recognising limitations and knowing when and how to seek help is all important. This is equally important in the clinic and in regards to one's own wellbeing. The speakers in this episode describe how they maintain a healthy balance within and around their careers.

Guests
Dr Marion Leighton FRACP (Wellington Hospital)
Dr Martina Moorkamp FRACP (Mercy Hospital for Women, Melbourne)
Dr Lawrence Ong FRACP (Westmead Institute For Medical Research)
Dr Ben Vogler FRACP (Cairns Hospital).

Production
This episode was produced by Zacha Rosen, with research assistance from Beverly Bucalon, and hosted by Mic Cavazzini. Recording in Wellington by Ryan Smith. Music courtesy of Lee Rosevere ('Thoughtful', 'Here's the Thing'), Chris Zabriskie ('Wonder Cycle'), and Rosie Catalano ('Waiting'); photo copyright RACP. The production manager was Anne Fredrickson.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

Next Episode

Ep30: Being Human

The World Medical Association has just updated the Physician's Oath in the Declaration of Geneva to include the clause, 'I will attend my own health, well-being, and abilities in order to provide care of the highest standard.' This is in recognition of the often reported figures about burnout, depression and suicide in the health workforce.

These rates are typically twofold higher than they are in the general population, according to studies from New Zealand, Australia and around the world. Causes often given for psychiatric distress in the medical profession are the gruelling hours, the pressure of perfection, the unforgiving culture and the stigma associated with mental health issues. This episode examines how the system might be shaped to improve physician wellbeing.

If you or someone you know is struggling with mental health issues, please seek help—call Lifeline on 13 11 14. The RACP also provides a confidential, 24-hour support program for its members. Fellows can call 1300 687 327 in Australia, and 0800 666 367 in New Zealand.

Guests
Dr Geoff Toogood FRACP (Alfred Hospital)
Dr Margaret Kay FRACGP (University of Queensland; Medical Director, Queensland Doctors' Health Program)
Dr Hilton Koppe FRACGP.

Production
Produced by Mic Cavazzini. Recording assistance from Michelle Ransom-Hughes and Rebecca Fary. Music courtesy of Kai Engel ('Highway to the Stars'), Cory Gray ('Low Rollers'), Blue Dot Sessions ('Periodicals') and Lee Rosevere ('Here's the Thing'). Photo via iStock. The production manager was Anne Fredrickson.

Editorial feedback for this episode was provided by RACP Fellows Dr Marion Leighton, Dr Alan Ngo, Dr Michael Herd, Dr Phillipa Wormald and Dr Paul Jauncey.
Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.