International Deprescribing Guidelines Did Not Impact Actual Practice in Deprescribing of Potentially Inappropriate Medications for Nursing Home Residents: An Interrupted Time Series Analysis.

IF 3.4 3区 医学 Q2 GERIATRICS & GERONTOLOGY
Degefaye Zelalem Anlay, Kristel Paque, Bart Van den Eynden, Tinne Dilles, Joachim Cohen
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Abstract

Background: Deprescribing guidelines reduce the use of potentially inappropriate medications (PIMs) in trial settings; however, their real-world impact remains unclear. Therefore, this study assesses deprescribing trends and the impact of guideline publications (STOPPFrail, proton pump inhibitors [PPIs], and antipsychotics) on these trends among nursing home residents with limited life expectancy in Belgium.

Methods: Deprescribing was assessed using linked healthcare reimbursement data for all residents aged 65 years and older who died between 2014 and 2019. In total, 15 PIMs from STOPPFrail version 1 were selected. Deprescribing was operationalized as discontinuing at least one PIM in the last 4 months of life among those who had been prescribed these medications chronically between 6-12 months prior to death. To identify changes in the trend of deprescribing, we employed a joinpoint linear regression model. We calculated the average quarterly percent change (AQPC) and 95% confidence intervals (CIs). In addition, we used autoregressive integrated moving average (ARIMA) modeling to explore the impact of publication of these guidelines on four commonly used PIMs: PPIs, antipsychotics, lipid modifying agents, and calcium.

Results: Among 244,865 residents, 169,782 (69.3%) were chronically prescribed at least one PIM and 50,487 (29.7%) had at least one discontinued. The prevalence of deprescribing declined from 31.7 to 27.66% between the first quarter of 2014 and the fourth quarter of 2019, with an average quarterly percent change decline of - 0.47% (95% CI - 0.85, - 0.10). No joinpoints were identified, indicating a consistent linear trend with no interruptions or statistically significant shifts in the rate of change in deprescribing prevalence. ARIMA modeling found that the publication of deprescribing guidelines had no impact on deprescribing trends.

Conclusions: Despite the high use of PIMs, and the publication of the STOPPFrail, PPI, and antipsychotic deprescribing guidelines, deprescribing rates remained low and even decreased. These findings emphasize the importance of implementation efforts that go well beyond guideline publications to effectively change deprescribing practices.

国际处方指导原则并未影响为疗养院居民开具潜在不当药物处方的实际做法:中断时间序列分析
背景:处方指导原则减少了试验环境中潜在不适当药物(PIMs)的使用,但其对现实世界的影响仍不明确。因此,本研究评估了比利时寿命有限的疗养院居民的去处方化趋势以及指南出版物(STOPPFrail、质子泵抑制剂 [PPIs] 和抗精神病药)对这些趋势的影响:利用2014年至2019年期间死亡的所有65岁及以上居民的关联医疗报销数据,对去处方化情况进行评估。共选取了 STOPPFrail 版本 1 中的 15 个 PIMs。去处方化的操作方法是,在死亡前 6-12 个月内长期服用这些药物的患者在生命的最后 4 个月内至少停用一种 PIM。为了确定去处方化趋势的变化,我们采用了连接点线性回归模型。我们计算了平均季度百分比变化 (AQPC) 和 95% 置信区间 (CI)。此外,我们还使用了自回归综合移动平均(ARIMA)模型来探讨这些指南的发布对四种常用 PIMs 的影响:结果:在 244,865 名居民中,169,782 人(69.3%)长期服用至少一种 PIM,50,487 人(29.7%)停用至少一种 PIM。从 2014 年第一季度到 2019 年第四季度,停药率从 31.7% 下降到 27.66%,平均季度百分比变化降幅为-0.47%(95% CI - 0.85, - 0.10)。没有发现连接点,这表明去处方化流行率的变化趋势是一致的线性趋势,没有中断,也没有统计学意义上的显著变化。ARIMA模型发现,去处方化指南的发布对去处方化趋势没有影响:结论:尽管 PIMs 的使用率很高,而且 STOPPFrail、PPI 和抗精神病药物去处方化指南也已发布,但去处方化率仍然很低,甚至有所下降。这些发现强调了实施工作的重要性,这些工作远不止于发布指南,而是要有效地改变处方实践。
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来源期刊
Drugs & Aging
Drugs & Aging 医学-老年医学
CiteScore
5.50
自引率
7.10%
发文量
68
审稿时长
6-12 weeks
期刊介绍: Drugs & Aging delivers essential information on the most important aspects of drug therapy to professionals involved in the care of the elderly. The journal addresses in a timely way the major issues relating to drug therapy in older adults including: the management of specific diseases, particularly those associated with aging, age-related physiological changes impacting drug therapy, drug utilization and prescribing in the elderly, polypharmacy and drug interactions.
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