What Is Known About Preventing, Detecting, and Reversing Prescribing Cascades: A Scoping Review

Abstract

OBJECTIVES: To systematically describe the resources available on preventing, detecting, and reversing prescribing cascades using a scoping review methodology. MEASUREMENTS: We searched Medline, EMBASE, Psy-chINFO, CINAHL, Cochrane Library, and Sociological Abstracts from inception until July 2017. Other searches (Google Scholar, hand searches) and expert consultations were performed for resources examining how to prevent, detect, or reverse prescribing cascades. We used these three categories along the prescribing continuum as an organizing framework to categorize and synthesize resources. RESULTS: Of 369 resources identified, 58 met inclusion criteria; 29 of these were categorized as preventing, 20 as detecting, and 9 as reversing prescribing cascades. Resources originated from 14 countries and mostly focused on older adults. The goal of preventing resources was to educate and increase general awareness of the concept of prescribing cascades as a way to prevent inappropriate prescribing and to illustrate application of the concept to specific drugs (e.g., anticholinergics) and conditions (e.g., inflammatory bowel disease). Detecting resources included original investigations or case reports that identified prescribing cascades using health administrative data, patient cohorts, and novel sources such as social media. Reversing prescribing cascade resources focused on the medication review process and deprescribing initiatives. CONCLUSION:Prescribing cascades are a recognized problem internationally. By learning from the range of resources to prevent, detect, and reverse prescribing cascades, this review contributes to improving drug prescribing, especially in older adults.

Use of potentially inappropriate medication and polypharmacy in older adults: a repeated cross-sectional study

“…This negative spiral of prescribing to treat side effects or interactions is also known as the prescribing cascade and increases the risk of polypharmacy. The risk of a prescribing cascade increases both with interactions (drug-drug) and contraindications (drug-disease) [10,11]. Nonetheless, polypharmacy is not wrong, per se, as long as the complete medication list is reviewed, and the risk/benefit ratio is considered for the individual patient, which is called appropriate polypharmacy [1,12].…”

Assessing the Scope and Appropriateness of Prescribing Cascades

“…3 Prescribing cascades are an important, yet underrecognized, contributor to polypharmacy. 4 The term refers to a sequence of events that begins when an adverse drug event (ADE) is misinterpreted as a new medical condition, and a subsequent drug is then inadvertently prescribed to treat this ADE. 5,6 As the term has gained increasing recognition, questions have arisen regarding nuances of the definition.…”

Use of potentially inappropriate medication and polypharmacy in older adults: a repeated cross-sectional study

“…Adverse drug events increases the risk of hospitalisations [4]. Use of medication increases with age even after adjustment of level of multimorbidity and polypharmacy increases the risk of drug-drug interaction considerably [5,6]. One could argue that the severity of the morbidity is increasing with age and therefore the number of medications increases.…”

“…This negative spiral of prescribing to treat side effects or interactions is also known as the prescribing cascade and increases the risk of polypharmacy. The risk of prescribing cascade increases with both interactions (drug-drug) and contraindications (drug-disease) [5,10].…”