Bayliss Elizabeth A, Powers J David, Weffald Linda A, Rasmussen Jon R, Pieper Lisa E, Maiyani Mahesh, Norton Jonathan, Green Ariel R, Sheehan Orla C, Boyd Cynthia M
Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA; Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA.
J Am Med Dir Assoc. 2025 Aug;26(8):105708. doi: 10.1016/j.jamda.2025.105708. Epub 2025 Jun 14.
The Centers for Medicare and Medicaid Services Polypharmacy-CNS (Poly-CNS) quality metric identifies individuals taking multiple medications with central nervous system side effects. The Poly-CNS measure may reduce risky prescribing for persons living with dementia (PLWD).
Secondary analysis of the Optimize cluster randomized pragmatic trial of deprescribing education in primary care conducted between April 1, 2019, and March 31, 2020.
Two overlapping cohorts of PLWD taking 5+ chronic medications. The "full intervention" cohort was randomized at the clinic level to receive patient and clinician deprescribing education materials. The "clinician education cohort" included additional individuals whose clinicians received educational materials but who did not receive patient materials.
Description of individuals meeting Poly-CNS criteria based on pharmacy dispensing records and their highest frequency combinations of medications. Generalized linear mixed models compared the odds of meeting Poly-CNS criteria by intervention or control group and modeled associations between patient characteristics and CNS polypharmacy at any time. Longitudinal analysis using generalized linear mixed models assessed trends of meeting Poly-CNS criteria over time.
The proportion meeting Poly-CNS criteria at any time during the observation period in the full intervention cohort (N = 2908) was 12.3% and 10.8% in the clinician education cohort (N = 5226). Adjusted P value for trend over time in the combined full intervention cohort was .0587, and <.0001 in the clinician education cohort. There was no effect of the intervention on odds of meeting Poly-CNS criteria in either cohort. Characteristics in both cohorts independently associated with meeting Poly-CNS criteria were younger age, greater morbidity burden, and female sex plus hospice use at baseline in the full intervention cohort. The most commonly combined medications were opioids plus antidepressants plus gabapentin.
Individuals with cognitive limitations and multimorbidity pharmacologically treated for mood and/or pain symptoms may be at risk for CNS polypharmacy.
医疗保险和医疗补助服务中心的多重用药 - 中枢神经系统（Poly - CNS）质量指标用于识别服用多种具有中枢神经系统副作用药物的个体。Poly - CNS指标可能会减少对痴呆症患者（PLWD）的高风险处方。
对2019年4月1日至2020年3月31日期间在初级保健中进行的撤药教育优化整群随机实用试验进行二次分析。
两个重叠的服用5种及以上慢性药物的PLWD队列。“全面干预”队列在诊所层面随机分组，以接受患者和临床医生的撤药教育材料。“临床医生教育队列”包括另外一些个体，他们的临床医生收到了教育材料，但他们自己没有收到患者材料。
根据药房配药记录描述符合Poly - CNS标准的个体及其最高频率的药物组合。广义线性混合模型比较了干预组或对照组符合Poly - CNS标准的几率，并对患者特征与任何时候的中枢神经系统多重用药之间的关联进行建模。使用广义线性混合模型的纵向分析评估了随时间符合Poly - CNS标准的趋势。
在全面干预队列（N = 2908）中，观察期内任何时间符合Poly - CNS标准的比例为12.3%，在临床医生教育队列（N = 5226）中为10.8%。在合并的全面干预队列中，随时间变化趋势的调整P值为0.0587，在临床医生教育队列中为<0.0001。干预对两个队列中符合Poly - CNS标准的几率均无影响。两个队列中与符合Poly - CNS标准独立相关的特征包括年龄较小、发病率负担较重，以及在全面干预队列中基线时为女性且使用临终关怀服务。最常联合使用的药物是阿片类药物加抗抑郁药加加巴喷丁。
因情绪和/或疼痛症状接受药物治疗的认知受限和患有多种疾病的个体可能存在中枢神经系统多重用药风险。
