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Discontinuation Categories Underlying Gaps in Dispensing for Six Medication Groups.

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Identifying medication discontinuations accurately is crucial for deprescribing research. Gaps in dispensing are imprecise proxies; this study categorized reasons for these gaps to improve data-based identification methods.

Keywords:
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Area of Science:

  • Geriatric Medicine
  • Pharmacology
  • Health Services Research

Background:

  • Accurate identification of medication discontinuations is vital for deprescribing research.
  • Gaps in pharmacy dispensing are often used as proxies for discontinuation but lack precision.

Purpose of the Study:

  • To categorize reasons for gaps in medication dispensing.
  • To inform the development of data-based methods for accurately identifying medication discontinuations.

Main Methods:

  • Reviewed pharmacy dispensing data for adults aged 65+ with multiple chronic conditions experiencing 90-day dispensing gaps.
  • Classified gaps as true discontinuations or non-discontinuations based on clinical documentation.
  • Analyzed various medication classes including diabetes drugs, statins, and antihypertensives.

Main Results:

  • Of 1906 records, 56% were true discontinuations and 44% were non-discontinuations.
  • True discontinuations included provider intent, substitutions, and planned restarts.
  • Non-discontinuations involved adherence issues, dose changes, and formulary or formulation changes.

Conclusions:

  • Using dispensing gaps as proxies for discontinuation can lead to misclassification bias.
  • The varied reasons for discontinuation complicate causal interpretations in research.