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Discontinuation Categories Underlying Gaps in Dispensing for Six Medication Groups
Elizabeth A Bayliss1,2, Glenn K Goodrich1, Jennifer C Barrow1
1Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA.
Pharmacoepidemiology and Drug Safety
|April 8, 2025
Summary
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.
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.
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