Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA.
Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
J Am Geriatr Soc. 2022 Sep;70(9):2487-2497. doi: 10.1111/jgs.17894. Epub 2022 Jun 1.
Interpreting results from deprescribing interventions to generate actionable evidence is challenging owing to inconsistent and heterogeneous outcome definitions between studies. We sought to characterize deprescribing intervention outcomes and recommend approaches to measure outcomes for future studies. A scoping literature review focused on deprescribing interventions for polypharmacy and informed a series of expert panel discussions and recommendations. Twelve experts in deprescribing research, policy, and clinical practice interventions participating in the Measures Workgroup of the US Deprescribing Research Network sought to characterize deprescribing outcomes and recommend approaches to measure outcomes for future studies. The scoping review identified 125 papers reflecting 107 deprescribing studies. Common outcomes included medication discontinuation, medication appropriateness, and a broad range of clinical outcomes potentially resulting from medication reduction. Panel recommendations included clearly defining clinically meaningful medication outcomes (e.g., number of chronic medications, dose reductions), ensuring adequate sample size and follow-up time to capture clinical outcomes resulting from medication discontinuation (e.g., quality of life [QOL]), and selecting appropriate and feasible data sources. A new conceptual model illustrates how downstream clinical outcomes (e.g., reduction in falls) should be interpreted in the context of initial changes in medication measures (e.g., reduction in mean total medications). Areas needing further development include implementation outcomes specific to deprescribing interventions and measures of adverse drug withdrawal events. Generating evidence to guide deprescribing is essential to address patient, caregiver, and clinician concerns about the benefits and harms of medication discontinuation. This article provides recommendations and an initial conceptual framework for selecting and applying appropriate intervention outcomes to support deprescribing research.
由于研究之间的结果定义不一致且存在差异，因此解释减药干预措施的结果以生成可行的证据具有挑战性。我们旨在描述减药干预措施的结果，并为未来的研究推荐衡量结果的方法。一项以治疗多种药物处方为重点的范围广泛的文献综述为一系列专家小组讨论和建议提供了信息。参与美国减药研究网络措施工作组的 12 名减药研究、政策和临床实践干预方面的专家，旨在描述减药结果并为未来的研究推荐衡量结果的方法。该范围综述确定了 125 篇反映 107 项减药研究的论文。常见的结果包括药物停用、药物适当性以及可能因药物减少而产生的广泛的临床结果。小组建议包括明确界定具有临床意义的药物结果（例如，慢性药物数量、剂量减少），确保有足够的样本量和随访时间来捕捉因药物停用而产生的临床结果（例如，生活质量[QOL]），并选择合适和可行的数据来源。一个新的概念模型说明了如何在药物测量初始变化的背景下解释下游临床结果（例如，跌倒减少），药物测量初始变化（例如，平均总药物减少）。需要进一步发展的领域包括针对减药干预措施的实施结果和药物撤药不良事件的衡量措施。生成指导减药的证据对于解决患者、护理人员和临床医生对药物停用的益处和危害的担忧至关重要。本文提供了建议和初步的概念框架，用于选择和应用适当的干预结果，以支持减药研究。
