Polypharmacy is a common problem in primary care. It is defined loosely as the use of 5-10 medications or more and is estimated to affect over 50% of Medicare beneficiaries and over 84% of elderly cancer patients. All of this medication is associated with increased risk of experiencing an adverse drug reaction and hospitalization. “Deprescribing” is the process of reducing the dose or stopping certain medications that have potential to cause harm. The Deprescribing movement has focused on the geriatric population and issues with polypharmacy.
Current recommendations from the American Geriatrics Society via Choosing Wisely states: “Don’t prescribe a medication without conducting a drug regimen review. Older patients disproportionately use more prescription and nonprescription drugs than other populations, increasing the risk for side effects and inappropriate prescribing. Annual review of medications is an indicator for quality prescribing in vulnerable elderly.”
Here on iMedicalApps we have reviewed many geriatrics apps including many from the American Geriatrics Society including Geriatrics at Your Fingertips, Multimorbidity/MCC GEMS, and iGeriatrics and most recently, Edmonton Frail Scale and ePrognosis. iGeriatrics includes the popular Beers Criteria to aid in deprescribing. Also popular are the STOPP criteria found here. None of these medical apps lists are based on particularly solid evidence but are great starting points to discussing deprescribing with patients and their families.
The latest addition to deprescribing comes from McCormack, et al. in Canada. Dr James McCormack is probably best known as one half the “Car Talk” like podcast (along with Dr Mike Allan), The Best Science Medicine Podcast. This is one of my go-to podcasts for keeping up with some of the latest and greatest drug treatment evidence. Dr McCormack assembled a superstar team of deprecribers to create a free website tool called MedStopper to help providers navigate the difficult decision making of stopping medications.
Login to iMedicalApps in order to view the following video review of MedStopper. In the video we show how to make MedStopper a webapp for your iPad and how to use the app with your patients. Registration for iMedicalApps is free.
Evidence based medicine
The MedStopper web app is largely based on expert opinion from renowned evidence based medicine experts and deprescribing experts. The medical tool includes other deprescribing resources such as Beers and STOPP criteria as well as the validated Edmonton Frail Scale. There are several decision tools for evidence based practice. The software powering the “decisions” requires somewhat of a leap of faith.
Who would benefit from this App?
Any healthcare provider who cares for geriatric patients or patients of any age on too many medications including students, NP’s, PA’s, geriatricians and other primary care providers.
Available at: www.medstopper.com
Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.
- Fast user interface with built in medications, indications, frail scale, stop plan.
- Easy to use at the point of care with patients and families.
- Fills a need for robust deprescribing resource.
- Website only; no apps. In our video we show how you can make this into a web-app on your iPhone or iPad.
- Indication categories must be chosen carefully to not alter results significantly.
- Methods behind deprescribing “logic” largely expert opinion, but reasonable.
MedStopper is a highly useful and valuable new tool for providers caring for geriatric patients or any patient on “too many” medicines — polypharmacy. The medical tool comes from reputable authors without pharma influence and presents an easy to follow strategy to deprescribing medications — helping you reduce the number of medications your patients are on effectively.
- Overall Score
- User Interface
Intuitive interface with built in Edmonton Frail Scale, printable MedStopper plan, tapering and side effects information. Can initially be a bit much till you use it a few times.
- Multimedia Usage
The website contains abundant information including data from BEERS and STOPP, linked references, incorporates the Edmonton Frail Scale and numerous websites from co-authors on deprescribing.
Website is free.
- Real World Applicability
For providers caring for geriatric patients, the MedStopper website is invaluable to assist both providers and patients in shared decision making regarding deprescribing. I only wish the authors had made it a bit more clear up front how the program “thinks” about the rankings of the medications to stop. It would also be great as a true dedicated medical app.
- Device Used For Review
iPad Air2 running iOS 9.2
- Available for DownloadAndroidiPhoneiPad