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Dr. Carolyn Thorpe (photo via UNC)
Dr. Carolyn Thorpe is a tenured associate professor at the University of North Carolina at Chapel Hill’s Eshelman School of Pharmacy, specifically in the division of pharmaceutical outcomes and policy. She also holds a joint appointment as a core investigator with the Veterans Affairs Pittsburgh Healthcare System. Her research primarily focuses on geriatric populations, and the implementation of programs designed to assist older patients with complex and chronic conditions.
“Our study in the VA is focused on nursing home residents who have multiple chronic conditions, many of whom are really frail and only have a couple of months or maybe a year or two of life left,” said Thorpe. “Many of them have advanced dementia and so we’re really interested in seeing how their chronic diseases are being managed and whether or not we can back off on some of their medications without causing harm.”
Specifically citing a situation where an older patient — at a higher risk of hypoglycemia due to the simple fact of age — may be receiving treatment for diabetes and taking medication to regulate blood sugar that could pose risks in the short run. Thorpe disputes the assumption that more medication is a satisfactory solution in an environment where treatment should be tailored to individual cases.
“Patients who have diabetes might be prescribed medication that very tightly controls their blood sugar, which was appropriate for them when they were younger,” said Thorpe. “But as they approach the last years of their lives, the goals of treatment may change … to avoid the short term negative effects of hypoglycemia, rather than a focus on the long-term benefits for controlling blood sugar that are not really achievable in these patients any longer.”
Dr. Thorpe’s work with the VA to improve the quality and safety of medication use in older veterans receiving care led to important policy changes that now require the VA and the Center for Medicare and Medicaid Services to share current information between the two agencies, essentially comparing notes as to what medicines are being prescribed to each patient and taking extra steps to prevent drug interactions or other safety issues.
“As you take more and more pills, it greatly increases the chance that you have a drug interaction or you have a side effect related to one of those medications,” said Thorpe. “It’s also just a big burden for patients and caregivers to manage their thinking about medications all day long … I became a lot more passionate about reducing overuse and inappropriate uses.”
The issue of drug overuse and over-prescription has recently made headlines cast in the light of a nationwide opioid crisis and epidemic, but not all cases are so dramatic or clean-cut. A prescription doesn’t have to be addictive or present clear and present danger to a patient in order to be a legitimate concern when it comes to effective treatment.
“There’s this assumption that more is better in healthcare,” said Thorpe. “To get people, both the providers and the patients and the families, to shift that perspective and think, ‘well more is not always better and maybe in this case less is better’ [can be difficult.] That’s not a natural way for us to think about healthcare, especially in this country.”
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