Recognizing, reversing and preventing prescribing cascades

Sometimes, an adverse drug reaction (ADR) of a medication is mistaken for a new health problem, which can lead to the prescription of additional medication. This chain reaction, known as a prescribing cascade, can result in unnecessary medication use, higher healthcare costs, hospitalizations, and a reduced quality of life for patients.
This research project aimed to better understand the occurrence, reversal and prevention of prescribing cascades. From international studies, 115 different prescribing cascades were identified, with recommendations on how to address some of them. For 66 prescribing cascades, we investigated whether these occurred in the Netherlands using data from community pharmacies. This appeared to be the case for 41 prescribing cascades. Another study examined whether prescribing cascades occurred after patients were started on new medications in the hospital. Results showed that, on average, 2% of patients developed a possible prescribing cascade within a year after hospital discharge. In many of these cases, the medication that may have been started to treat the ADR was prescribed by another healthcare provider.
Pharmacists can play a crucial role in addressing prescribing cascades. Nevertheless, a small-scale study showed that pharmacy-led strategies for preventing or reversing prescribing cascades were time-consuming. Although pharmacists successfully intervened in several cases, they highlighted the need for more efficient approaches and tools to identify and address prescribing cascades.
The insights from this thesis mark a first step toward better recognition, reversal, and prevention of prescribing cascades. This can support healthcare professionals reduce unnecessary medication use and improve patients’ well-being.