Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Center for Real-world Effectiveness and Safety of Therapeutics, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Department of Pharmacy, University of Washington School of Pharmacy, Seattle, WA, USA.
Parkinsonism Relat Disord. 2023 Sep;114:105793. doi: 10.1016/j.parkreldis.2023.105793. Epub 2023 Aug 6.
Parkinson disease (PD) patients are at increased risk of serious injury, such as fall-related fractures. Prescription medications are a modifiable factor for injury risk.
To determine the extent to which a serious injury requiring hospitalization affects prescribing of potentially inappropriate medications (PIMs) among older adults with PD.
We conducted a quasi-experimental difference-in-difference (DID) study using 2013-2017 Medicare data. The cohort consisted of beneficiaries with PD hospitalized for injury versus for other reasons. PIMs were classified into PD and injury-relevant categories (CNS-active PIMs, PD motor symptom PIMs, PD non-motor symptom PIMs, PIMs that reduce bone mineral density). We estimated mean standardized daily doses (SDDs) of medications within each PIM category before and at 3, 6, and 12 months after hospitalization. We used generalized linear regression models to compare changes in mean SDDs for each PIM category between the injury and non-injury group at each timepoint, adjusting for biological, clinical and social determinants of health variables.
Both groups discontinued PIMs and/or reduced PIM doses after hospitalization. There were no between-group differences in mean SDD changes, after covariate adjustment, for any PIM category, except for the CNS-active PIMs category at 3 months (DID p-value = 0.00) and for the category of PIMs that reduce bone mineral density at all timepoints (DID p-values = 0.02, 0.04, 0.02 at 3, 6, and 12 months).
Similar patterns of PIM among persons with PD after hospitalization for serious injury versus for other reasons may represent a missed opportunity to deprescribe high-risk medications during care transitions.
帕金森病（PD）患者发生严重伤害（如与跌倒相关的骨折）的风险增加。处方药物是伤害风险的一个可改变的因素。
确定因严重伤害（需要住院治疗）而住院的老年人中，需要住院治疗的严重伤害对潜在不适当药物（PIM）的处方的影响程度。
我们使用 2013-2017 年医疗保险数据进行了一项准实验性差异（DID）研究。该队列由因伤害住院的 PD 患者与因其他原因住院的患者组成。PIM 分为 PD 和与伤害相关的类别（CNS 活性 PIM、PD 运动症状 PIM、PD 非运动症状 PIM、降低骨密度的 PIM）。我们在住院前和住院后 3、6 和 12 个月，估算了每个 PIM 类别中的平均标准化日剂量（SDD）。我们使用广义线性回归模型比较了每个时间点的伤害组和非伤害组之间每个 PIM 类别的平均 SDD 变化，同时调整了健康的生物学、临床和社会决定因素变量。
两组患者在住院后均停止使用 PIM 和/或减少 PIM 剂量。在调整协变量后，除 3 个月时的 CNS 活性 PIM 类别（DID p 值=0.00）和所有时间点的降低骨密度的 PIM 类别（DID p 值=0.02、0.04、0.02 在 3、6 和 12 个月）外，各组之间的平均 SDD 变化没有差异。
PD 患者因严重伤害（需要住院治疗）和其他原因住院后，PIM 的使用模式相似，这可能代表在护理过渡期间未能减少高风险药物的使用。
