Innovator: Dr. Emily McDonald makes deprescribing a standard of care

It was during her residency in internal medicine, from 2009 to 2015 at McGill University, that Dr. Emily McDonald became aware of deprescribing. “I’ve often had the impression that in medicine, we sometimes do too much . . . whether it’s too many tests or too many treatments,” she says. As deprescribing was a new field of research at the time, the doctor saw this as an opportunity to get involved in this niche.Dr. McDonald now divides her time between teaching, as an assistant professor at the faculty of medicine at McGill University, the clinic and research, where she is interested in polypharmacy and deprescribing in the frail elderly population.She argues that polypharmacy is more widespread than we think.Read: Which drugs can increase fall risk in older adults?“It is not uncommon to see elderly people with 10 to 20 medications or doctors who renew prescriptions for 30 years without questioning their relevance or safety. This practice is not without risk for the patient,” says the doctor, who is also the scientific director of the Canadian Network for the Appropriate Use of Medications and Deprescribing.She deplores the fact that medical standards are not oriented toward deprescribing. “Medical schools or guidelines teach us how to initiate treatment, not how to end it.” With her work, she wishes to contribute to making deprescribing an integral part of standards of care.In 2015, with her colleague Dr. Todd Lee, she designed the MedSecure software. The effectiveness of the software has been clinically demonstrated in a study with a sample of almost 6,000 patient—the largest deprescribing study carried out to date in the world.Read: Deprescribing: finding the best fit for individual patientsIn 2019, after demonstrating its innovation and earning multiple awards, the clinical project transformed into a full-fledged business of which Dr. McDonald is now CEO.She wants to make her tool available to as many clinicians as possible by including it directly in electronic medical records (EMR) so that all doctors are comfortable deprescribing when it is safe and indicated. The software is also used in Ontario Long-Term Care Centers and is supported by a provincial drug safety technology funding program.In Quebec, MedSécure is currently used and tested in CHSLDs as part of the doctoral project of Émilie Bortolussi-Courval (winner of a 2023 Health Profession Prize, in the Innovative Practice category), under the direction of Dr. McDonald. However, the implementation of the software is hampered by the slow pace of computerization of the network.Dr. McDonald hopes deprescribing will soon become second nature to clinicians. Particular attention should be given to patients taking more than five medications or those who have been taking a medication for many years. “Fighting polypharmacy is a team effort. All health professionals who have the right to prescribe should also have the reflex to deprescribe,” she says.This article was translated from French and originally ran in our sister publication Profession Santé.

Innovator: Dr. Emily McDonald makes deprescribing a standard of care

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