BMJ Study Finds 24 Common Prescribing Cascades — SkimNews
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- Dr. Paula Rochon of Sinai Health led the BMJ-published study, which analyzed population-level prescription data from ICES in Ontario and identified 24 commonly observed prescribing cascades.
- The 24 cascades include patterns such as NSAIDs causing blood pressure increases that are treated as new hypertension with another prescription, rather than reconsidering the original pain medication.
- Statins and iron supplements were among widely used medications identified as drivers of prescribing cascades in older adults, who are particularly susceptible due to multiple conditions and concurrent medications.
- Mature women face elevated risk because over their lives they tend to experience more chronic conditions, receive more drug therapies, and have more adverse drug events than men.
- The research team narrowed an initial list of 65 potentially inappropriate prescribing cascades, developed by 12 international panelists, down to 24 by measuring prescription frequency and the strength of connection between sequential drugs.
- International collaborators came from the United States, Belgium, Italy, Israel, and Ireland, with the interdisciplinary team including geriatric medicine and clinical pharmacology experts.
- The authors recommend automated clinical decision support systems that flag when a new medication may be treating a side effect of an existing drug, alongside greater pharmacist involvement in prescribing decisions.
Why it matters: These 24 cascades represent a clinically invisible but common source of drug-related harm in older adults, with the research team pointing to two practical fixes: pharmacist-led medication reviews that document when and why each drug was started, and automated point-of-care alerts that flag possible cascades before another unnecessary prescription is added.
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