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November 13, 2018

Overcoming Inertia to Improve Medication Use and Deprescribing

Author Affiliations
  • 1Division of Geriatrics, University of California San Francisco, California
  • 2San Francisco VA Health Care System, San Francisco, California
  • 3Department of Medicine, University of Alabama at Birmingham
JAMA. 2018;320(18):1867-1869. doi:10.1001/jama.2018.16473

Inertia is a powerful force. Stopping or starting is difficult in health care as well as in other sciences. Ineffective or potentially harmful treatments are often not stopped, even years after they have been started, and effective treatments are too often not started at all.

Once started, medications can be difficult to stop. It takes time for office-based clinicians to reassess use of medications prescribed to patients with chronic diseases, particularly therapies that are not clearly related to the symptoms or conditions that are the focus of a given patient encounter. Even if a clinician recognizes a medication as potentially inappropriate and a candidate for discontinuation, both the clinician and the patient may be concerned that “the devil they know is better than the devil they don’t know,” and that stopping a medication may worsen symptoms or biomarkers or may be perceived as giving up. Clinicians also may be unsure about how to best taper different medications or how to recognize and manage adverse drug withdrawal events. Thus, use of unnecessary and potentially harmful medications is common among older adults.1