A Multi-Method Approach to Exploring Prescribing Cascades

Prescribing cascades occur when a drug is used to treat the side effect of another drug. We are studying how and why prescribing cascades start and continue, their impact on people, and how they can be prevented or reversed.

Our research began with two series of interviews with patients, caregivers and healthcare professionals to explore how and why prescribing cascades occur and to understand their impacts.

Using Michie’s Behaviour Change Wheel, we then identified strategies to help clinicians and patients identify prescribing cascades earlier and make them easier to manage or prevent altogether. Our team is currently gathering input on the feasibility of these strategies and exploring the design of tools for clinicians to use in practice.

Our goal is to help people identify prescribing cascades earlier or prevent them altogether in order to improve the health and well-being of older adults.

Funder (2017-2021): CIHR
Lead: Dr. Barbara Farrell
Co-investigators: Dr. Lianne Jeffs, Dr. Lisa McCarthy, Dr. Colleen Metge

Funder (2021-2023): University of Toronto’s Leslie Dan Faculty of Pharmacy
Lead: Dr. Lisa McCarthy
Co-investigators: Dr. Sameera Toenjes (graduate student), Dr. Barbara Farrell, Dr. Lianne Jeffs, Dr Colleen Metge, Dr. Sara Guilcher

Contact: deprescribing@deprescribing.org

Farrell, B.J., Jeffs, L., Irving, H. et al. Patient and provider perspectives on the development and resolution of prescribing cascades: a qualitative study. BMC Geriatr 20, 368 (2020). https://doi.org/10.1186/s12877-020-01774-7

Farrell, B, Galley, E, Jeffs, L, Howell, P, McCarthy, L. “Kind of blurry”: Deciphering clues to prevent, investigate and manage prescribing cascades. PLOS ONE (2022). https://doi.org/10.1371/journal.pone.0272418