Mr. Speaker, I am pleased to rise today to participate in this important debate. The legislation before us contains the four principles of accessibility, affordability, appropriateness and universality.
Today, I will speak to the principle of appropriateness, which relates to the appropriate prescribing and use of medicines. I will outline the importance of achieving a pan-Canadian strategy on the appropriate use of drugs, which is a key feature of this legislation. Notably, the World Health Organization defines “appropriate use” as follows: “patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community.”
Prescription drugs play a critical role in the day-to-day for Canadians. Every year, over 750 million prescriptions are filled by 18 million people in Canada. It is estimated that in any given month, 55% of adults and 23% of children and youth will take at least one prescription medication. Getting the right medication at the right time can be life-changing. Whether it is receiving a prescription for an inhaler to help an asthmatic patient breathe better or anti-hypertensive medication to bring down blood pressure and decrease the risk of heart attack or stroke, medications have the power to restore health and improve a person's quality of life. However, getting the wrong medication at the wrong time can cause significant unintended harms. In fact, adverse drug events are a leading cause of unplanned hospital visits, contributing to over two million emergency department visits and 700,000 hospital admissions in Canada every year.
Examples of appropriate use and action include an informed conversation between a patient and their health care provider on the best treatment to improve their health, opting to stop a medication that was once helpful and is now causing more harm than good, or a public awareness campaign on how to use antibiotics wisely. Unfortunately, a growing body of evidence suggests that inappropriate prescribing and use happen more often than they should. Consider that 21% of adults in Canada between the ages of 40 and 79 are currently taking more than five prescription medications at a time. This is called polypharmacy and it can increase a person's risk of falls by 75%, among other impacts.
Consider the story heard from a clinician about a patient who was taking over 25 different medications, the combined effects of which were taking a serious toll on their health and quality of life. This clinician stressed to us the significant time and effort required to support the patient and caregiver to slowly discontinue the inappropriate medications. A striking takeaway from this conversation was that this case was far from an anomaly in their practice.
Inappropriate prescribing can threaten patient safety and lead to negative health, social and financial impacts. Other significant examples, such as increased antibiotic resistance due to overuse that threatens patient safety, the risks of addiction and overdose from opioid misuse, and many problems and injuries related to the long-term use of sleeping pills, show this issue is widespread.
It is estimated that approximately 1.9 million Canadian seniors regularly use at least one inappropriate medication, which can lead to dizziness, memory problems, hospitalization and even death. The cost of these inappropriate prescriptions is over $419 million per year, and it rises to over $1.4 billion if the costs of hospital visits and the impacts of other harms are included.
Appropriate use was established as a shared priority among federal, provincial and territorial governments. Jurisdictions, health organizations and even local providers have implemented a variety of initiatives and programs to address the issue at hand. There is good work happening across the country, but those doing this important work have called for a unified approach so we can increase its impact and reach.
While there are several pockets of excellence addressing appropriate use, persistent gaps and challenges exist. Inconsistent reach, overlapping efforts and even duplication have limited the scale-up and spread of promising approaches across the health care system, which limits our ability to make these benefits available to people across the country. Without a devoted strategy to better connect our siloed work and improve collaboration, we risk stretching our already limited health system resources, and we will miss an opportunity to serve patients with the highest quality of care.
Other countries around the world have shown us that addressing appropriate use works and makes a difference in the health and safety of their citizens. Countries such as Australia, the U.K. and the Netherlands have developed a coordinated solution that addresses appropriate use at multiple levels and works to ensure that everyone, including patients, prescribers and the public, is motivated to make the necessary changes. In doing so, they have managed to improve prescribing and use behaviours while reducing the harms and health system costs of inappropriate care. Developing and implementing a pan-Canadian strategy that builds on this learning would help expand the impact and reach of successful appropriate use programs to better serve prescribers, patients, and diverse communities across the country.
To date, efforts to improve appropriate use, detect and respond to patient safety issues as they arise have been hampered by the uneven ability of prescribing data. This has significantly limited the supports available to patients and prescribers to make the best decisions regarding their care. Support to enhance the collection of and access to prescribing data will need to underpin any strategy. Addressing appropriate use of prescription drugs also presents a unique opportunity to tackle some of the most topical challenges facing our health system, such as appropriate therapies for mental health; access to safe, long-term care; and optimizing primary care.
The prescribing of antipsychotics in long-term care is a prime example where, at any given time, it is estimated that nearly one in four long-term care residents was receiving an antipsychotic drug while having no clinical reason for its use. These medications put patients at increased risk of falls, fractures and even strokes. Ultimately, healthier patients and fewer adverse drug events puts less stress on our health professionals and health care system.
Patients, health care providers and partners all agree that now is the time to act, and a pan-Canadian appropriate use strategy would bring the vision into reality. This means directing efforts towards implementing widespread programs and initiatives, collaborating closely to make meaningful change, ensuring that health policy promotes positive actions and bolstering evaluation of programs so we can scale and spread those programs that we know would make a difference.
We are already getting started. Last spring, the Canadian drug agency transition office established an appropriate use advisory committee, comprising organizations, prescribers, patients, insurers and health system partners, to provide guidance and advice for the development of a pan-Canadian appropriate use strategy. The committee will soon issue its final report. It is also working closely with key partners, including Choosing Wisely Canada and the Canadian Medication Appropriateness and Deprescribing Network to better coordinate existing efforts to further enhance its impact.
New health challenges continue to emerge, and the need for a coordinated appropriate use strategy to enhance quality of care, improve patient health and promote the judicious and equitable use of health care resources has become even more critical. Members can see that this strategy, guided by the CDA, would be an important element of moving forward with national pharmacare. Addressing appropriate use on a national scale would confront these challenges, knitting together our existing patchwork of programs to provide much-needed support for patients and prescribers while improving safety and outcomes, ultimately reducing the cost of burdens caused by inappropriate care.
We look forward to working closely with patients, prescribers, health partners and jurisdictions in making the program a reality.
