McDonald Emily G, Estey Justine L, Davenport Cody, Bortolussi-Courval Émilie, Gaudet Jeffrey, Wilson Registe Pierre Philippe, Lee Todd C, Goodine Carole
Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada.
JAMA Netw Open. 2025 May 1;8(5):e2512931. doi: 10.1001/jamanetworkopen.2025.12931.
Potentially inappropriate prescribing (PIP) is common, costly, and harmful. Deprescribing potentially inappropriate medications (PIMs) is a priority for improving the health outcomes of older adults. PIP is especially common in long-term care homes, with up to 88% of residents affected.
To assess the efficacy of electronic decision support for deprescribing in long-term care.
DESIGN, SETTING, AND PARTICIPANTS: This stepped-wedge cluster randomized trial took place from August 1, 2021, to October 31, 2022, during the COVID-19 pandemic. The study assessed older adults residing in 1 of 5 long-term care homes in New Brunswick, Canada, at the start of the study who were prescribed 1 or more PIMs. The 5 long-term care homes were divided into 3 clusters. All clusters spent at least 3 months in a control phase; every 3 months a cluster was randomized to enter the intervention phase. Data analysis was performed from October 15, 2023, to March 24, 2025.
Electronically generated, individualized reports that contained prioritized opportunities for deprescribing in older adults were paired with preexisting quarterly medication reviews. Deprescribing reports were accessed through a secure viewer.
The primary outcome was the proportion of residents with 1 or more PIMs deprescribed in the control phase vs intervention measured every 3 months after a medication review. For the primary outcome, an adjusted odds ratio (AOR) was calculated using a generalized linear model with a logit link, controlling for the effect of the intervention and adjusted for the number of PIMs, age, sex, language, and period as fixed effects and participants nested within sites as random effects.
A total of 725 residents participated in the study (median [IQR] age, 84 [76-90] years; 478 [65.9%] female). The median (IQR) number of medications was 10 (7-13), and the median (IQR) number of PIMs was 3 (2-4). In the control phase, the proportion of residents with 1 or more PIMs deprescribed was 92 of 725 (12.7%) compared with 226 of 621 (36.4%) during the intervention (AOR, 1.58; 95% CI, 1.07-2.34), in favor of the intervention.
This study found that electronic decision support paired with the usual workflow could render the deprescribing process scalable and effective. These results suggest that medication reviews should incorporate deprescribing as part of usual care.
ClinicalTrials.gov Identifier: NCT04762303.
潜在不适当处方（PIP）很常见，成本高昂且有害。停用潜在不适当药物（PIM）是改善老年人健康结局的优先事项。PIP在长期护理机构中尤为常见，高达88%的居民受到影响。
评估电子决策支持在长期护理中停用药物的疗效。
设计、设置和参与者：这项阶梯式楔形整群随机试验于2021年8月1日至2022年10月31日期间在新冠疫情期间进行。该研究评估了在研究开始时居住在加拿大新不伦瑞克省5所长期护理机构之一且被开具1种或更多PIM的老年人。这5所长期护理机构被分为3个群组。所有群组在对照阶段至少花费3个月；每3个月将一个群组随机分配进入干预阶段。数据分析于2023年10月15日至2025年3月24日进行。
电子生成的、包含老年人停用药物优先机会的个性化报告与现有的季度药物审查相结合。停用药物报告通过安全查看器获取。
主要结局是在药物审查后每3个月测量一次的对照阶段与干预阶段停用1种或更多PIM的居民比例。对于主要结局，使用具有logit链接的广义线性模型计算调整后的优势比（AOR），控制干预效果，并针对PIM数量、年龄、性别、语言和时期作为固定效应进行调整，将参与者嵌套在机构内作为随机效应。
共有725名居民参与了该研究（年龄中位数[四分位间距]为84[76 - 90]岁；478名[65.9%]为女性）。药物数量中位数（四分位间距）为10（7 - 13），PIM数量中位数（四分位间距）为3（2 - 4）。在对照阶段，停用1种或更多PIM的居民比例为725人中的92人（12.7%），而在干预阶段为621人中的226人（36.4%）（AOR为1.58；95%置信区间为1.07 - 2.34），支持干预措施。
本研究发现，电子决策支持与常规工作流程相结合可使停用药物过程具有可扩展性且有效。这些结果表明，药物审查应将停用药物纳入常规护理的一部分。
ClinicalTrials.gov标识符：NCT04762303。
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