Aspinall Sherrie L, Hanlon Joseph T, Niznik Joshua D, Springer Sydney P, Thorpe Carolyn T
VA Center for Medication Safety/Pharmacy Benefits Management Services, Hines, Illinois.
VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pennsylvania.
Innov Aging. 2017 Dec 20;1(2):igx031. doi: 10.1093/geroni/igx031. eCollection 2017 Sep.
Deprescribing, which includes stopping or reducing the dosage of medications, is designed to improve safety and prevent adverse drug reactions in older patients. To date, there has been limited work on measuring decreases in dosage intensity, or deintensification, across therapeutic classes of medications. Given the ongoing focus on central nervous system (CNS) medications and the frequency with which providers encounter hypertension and diabetes in older nursing home patients, the objective of this expert review is to describe and critique innovative composite dosage intensity measures that have been, or could be, applied to quantify deintensification within three therapeutic medication targets commonly encountered in nursing home patients: CNS agents, antihypertensive therapy, and antidiabetic therapy and the extent to which they are associated with health outcomes. Composite measures for CNS medication intensity considered dividing a patient's daily dose by defined daily dosage (DDD), or the minimum effective adult or geriatric daily dosage. In contrast, composite measures for antihypertensives used either DDD or maximum recommended daily dosage in the denominator. We were not able to identify any composite measure of intensity for antidiabetic classes. There was a paucity of interventional studies that showed reducing the dosage intensity resulted in improved health outcomes. In conclusion, we identified several innovative composite measures of dosage intensity for CNS and antihypertensive medications, and discussed possible approaches for developing an antidiabetic regimen composite measure. It is critical for future research to compare and contrast various measures and to determine their impact on important clinical outcomes.
减药（包括停药或减少药物剂量）旨在提高安全性并预防老年患者的药物不良反应。迄今为止，在衡量各类治疗药物的剂量强度降低或减量化方面的工作还很有限。鉴于目前对中枢神经系统（CNS）药物的关注，以及老年疗养院患者中医疗服务提供者遇到高血压和糖尿病的频率，本专家综述的目的是描述和评判已应用或可应用于量化疗养院患者常见的三个治疗药物靶点（CNS药物、抗高血压治疗和抗糖尿病治疗）内减量化情况的创新性复合剂量强度测量方法，以及它们与健康结果的关联程度。CNS药物强度的复合测量方法考虑将患者的每日剂量除以限定日剂量（DDD），即成人或老年患者的最小有效日剂量。相比之下，抗高血压药物的复合测量方法在分母中使用DDD或最大推荐日剂量。我们未能确定任何针对抗糖尿病药物类别的强度复合测量方法。很少有干预性研究表明降低剂量强度能改善健康结果。总之，我们确定了几种用于CNS和抗高血压药物的创新性剂量强度复合测量方法，并讨论了制定抗糖尿病治疗方案复合测量方法的可能途径。未来的研究必须对各种测量方法进行比较和对比，并确定它们对重要临床结果的影响，这一点至关重要。
