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Defining key deprescribing measures from electronic health data: A multisite data harmonization project.

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This summary is machine-generated.

Standardized definitions for deprescribing chronic medications like benzodiazepines and Z-drugs are crucial for older adults. A 90-day gap or "halo" period better captures discontinuation than shorter gaps, and dispensing data is more accurate than order data.

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Area of Science:

  • Gerontology
  • Pharmacology
  • Health Informatics

Background:

  • Deprescribing (stopping or reducing medications) can improve older adults' health.
  • Standardized measures for electronic health data are lacking for deprescribing studies.
  • Variations in data types and availability across healthcare systems hinder research.

Purpose of the Study:

  • To develop and apply standardized definitions for chronic medication use and discontinuation using electronic health data.
  • To assess the impact of different data types (medication orders vs. dispensings) and definition parameters on deprescribing estimates.
  • To evaluate benzodiazepine and Z-drug deprescribing in older adults across diverse US healthcare systems.

Main Methods:

  • Retrospective cohort study of adults aged 65+ with chronic benzodiazepine or Z-drug use (2017-2019).
  • Development of definitions for chronic use and discontinuation based on medication orders and/or dispensings.
  • Analysis of varying gap lengths and a 30-day "halo" period for discontinuation, comparing order vs. dispensing data.

Main Results:

  • Chronic benzodiazepine/Z-drug use affected 1.6%-2.6% of older adults (N=6775).
  • Discontinuation rates varied significantly (6%-49%) based on definition and site.
  • A 90-day gap or "halo" reduced discontinuation estimates; dispensing data showed higher discontinuation rates than order data.

Conclusions:

  • A gap of ≥90 days or a "halo" period may provide more accurate discontinuation estimates.
  • Medication orders underestimate discontinuation compared to dispensing data.
  • Further work is needed to adapt these definitions for other drug classes and settings.