Patterns of oral bisphosphonate deprescribing in older nursing home residents with dementia

Niznik, Joshua D.; Aspinall, Sherrie L.; Hanson, Laura C.; Gilliam, M.; Li, Xintong; Kelley, Casey J.; Thorpe, Carolyn T.

doi:10.1007/s00198-021-06141-9

Cited by 16 publications

(10 citation statements)

References 35 publications

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“…We were limited in our ability to present detailed quantitative data from our EHR-linked data due to small cell sizes and policy stipulations to 29 statins, 30 beta blockers, 18 and bisphosphonates. 16 However, few studies have reported extensively on the agreement between different claims-based definitions. In Niznik et al, 16 the authors examined different claims-based definitions for deprescribing bisphosphonates.…”

Section: Discussionmentioning

confidence: 99%

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Validating claims‐based definitions for deprescribing: Bridging the gap between clinical and administrative data

Niznik,

Shmuel,

Pate

et al. 2024

Pharmacoepidemiology and Drug

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BackgroundLimited research has evaluated the validity of claims‐based definitions for deprescribing.ObjectivesEvaluate the validity of claims‐based definitions of deprescribing against electronic health records (EHRs) for deprescribing of benzodiazepines (BZDs) after a fall‐related hospitalization.MethodsWe used a novel data linkage between Medicare fee‐for‐service (FFS) and Part D with our health system's EHR. We identified patients aged ≥66 years with a fall‐related hospitalization, continuous enrollment in Medicare FFS and Part D for 6 months pre‐ and post‐hospitalization, and ≥2 BZD fills in the 6 months pre‐hospitalization. Using a standardized EHR abstraction tool, we adjudicated deprescribing for a sub‐sample with a fall‐related hospitalization at UNC. We evaluated the validity of claims‐based deprescribing definitions (e.g., gaps in supply, dosage reductions) versus chart review using sensitivity and specificity.ResultsAmong 257 patients in the overall sample, 44% were aged 66–74 years, 35% had Medicare low‐income subsidy, 79% were female. Among claims‐based definitions using gaps in supply, the prevalence of BZD deprescribing ranged from 8.2% (no refills) to 36.6% (30‐day gap). When incorporating dosage, the prevalence ranged from 55.3% to 65.8%. Among the validation sub‐sample (n = 47), approximately one‐third had BZDs deprescribed in the EHR. Compared to EHR, gaps in supply from claims had good sensitivity, but poor specificity. Incorporating dosage increased sensitivity, but worsened specificity.ConclusionsThe sensitivity of claims‐based definitions for deprescribing of BZDs was low; however, the specificity of a 90‐day gap was >90%. Replication in other EHRs and for other low‐value medications is needed to guide future deprescribing research.

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Section: Discussionmentioning

confidence: 99%

“…16 However, few studies have reported extensively on the agreement between different claims-based definitions. In Niznik et al, 16 the authors examined different claims-based definitions for deprescribing bisphosphonates. The prevalence of deprescribing ranged from 12% to 32% for prescription gaps of 30 to 180 days.…”

Section: Discussionmentioning

confidence: 99%

Validating claims‐based definitions for deprescribing: Bridging the gap between clinical and administrative data

Niznik,

Shmuel,

Pate

et al. 2024

Pharmacoepidemiology and Drug

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“…Our outcome was time until the first day of a gap in ASM supply of various durations in 2016–2018 based on part D fill data. This definition used established methodology from work outside of epilepsy, which similarly used administrative claims data to evaluate the frequency of medication discontinuation [ 35 , 36 ]. Furthermore, work within epilepsy has similarly used large prescription claims to capture retention rates of ASMs [ 37 , 38 ] and patterns of ASM use [ 39 ].…”

Section: Methodsmentioning

confidence: 99%

Incidence of and predictors for antiseizure medication gaps in Medicare beneficiaries with epilepsy: a retrospective cohort study

et al. 2022

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Background For the two-thirds of patients with epilepsy who achieve seizure remission on antiseizure medications (ASMs), patients and clinicians must weigh the pros and cons of long-term ASM treatment. However, little work has evaluated how often ASM discontinuation occurs in practice. We describe the incidence of and predictors for sustained ASM fill gaps to measure discontinuation in individuals potentially eligible for ASM withdrawal. Methods This was a retrospective cohort of Medicare beneficiaries. We included patients with epilepsy by requiring International Classification of Diseases codes for epilepsy/convulsions plus at least one ASM prescription each year 2014–2016, and no acute visit for epilepsy 2014–2015 (i.e., potentially eligible for ASM discontinuation). The main outcome was the first day of a gap in ASM supply (30, 90, 180, or 360 days with no pills) in 2016–2018. We displayed cumulative incidence functions and identified predictors using Cox regressions. Results Among 21,819 beneficiaries, 5191 (24%) had a 30-day gap, 1753 (8%) had a 90-day gap, 803 (4%) had a 180-day gap, and 381 (2%) had a 360-day gap. Predictors increasing the chance of a 180-day gap included number of unique medications in 2015 (hazard ratio [HR] 1.03 per medication, 95% confidence interval [CI] 1.01–1.05) and epileptologist prescribing physician (≥25% of that physician’s visits for epilepsy; HR 2.37, 95% CI 1.39–4.03). Predictors decreasing the chance of a 180-day gap included Medicaid dual eligibility (HR 0.75, 95% CI 0.60–0.95), number of unique ASMs in 2015 (e.g., 2 versus 1: HR 0.37, 95% CI 0.30–0.45), and greater baseline adherence (> 80% versus ≤80% of days in 2015 with ASM pill supply: HR 0.38, 95% CI 0.32–0.44). Conclusions Sustained ASM gaps were rarer than current guidelines may suggest. Future work should further explore barriers and enablers of ASM discontinuation to understand the optimal discontinuation rate.

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“…Recognized clinical factors associated with an increased need for deprescribing include multimorbidity, polypharmacy, transitions of care, and the presence of certain chronic conditions that increase the patient's risk for adverse drug events or other medication-related harms, such as Alzheimer's disease and related dementias [64][65][66][67][68][69][70][71].…”

Section: Barriers and Enablers Of Deprescribingmentioning

confidence: 99%

Implementation considerations of deprescribing interventions: A scoping review

et al. 2023

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Over half of older adults experience polypharmacy, including medications that may be inappropriate or unnecessary. Deprescribing, which is the process of discontinuing or reducing inappropriate and/or unnecessary medications, is an effective way to reduce polypharmacy. This review summarizes (1) the process of deprescribing and conceptual models and tools that have been developed to facilitate deprescribing, (2) barriers, enablers, and factors associated with deprescribing, and (3) characteristics of deprescribing interventions in completed trials, as well as (4) implementation considerations for deprescribing in routine practice. In conceptual models of deprescribing, multilevel factors of the patient, clinician, and health‐care system are all related to the efficacy of deprescribing. Numerous tools have been developed for clinicians to facilitate deprescribing, yet most require substantial time and, thus, may be difficult to implement during routine health‐care encounters. Multiple deprescribing interventions have been evaluated, which mostly include one or more of the following components: patient education, medication review, identification of deprescribing targets, and patient and/or provider communication about high‐risk medications. Yet, there has been limited consideration of implementation factors in prior deprescribing interventions, especially with regard to the personnel and resources in existing health‐care systems and the feasibility of incorporating components of deprescribing interventions into the routine care processes of clinicians. Future trials require a more balanced consideration of both effectiveness and implementation when designing deprescribing interventions.

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Patterns of oral bisphosphonate deprescribing in older nursing home residents with dementia

Cited by 16 publications

References 35 publications

Validating claims‐based definitions for deprescribing: Bridging the gap between clinical and administrative data

Validating claims‐based definitions for deprescribing: Bridging the gap between clinical and administrative data

Incidence of and predictors for antiseizure medication gaps in Medicare beneficiaries with epilepsy: a retrospective cohort study

Implementation considerations of deprescribing interventions: A scoping review

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