Methods for evaluating the benefit and harms of deprescribing in observational research using routinely collected data

Moriarty, F (通讯作者),Univ Med & Hlth Sci, Sch Pharm & Biomol Sci, Royal Coll Surg Ireland RCSI, 123 St Stephens Green, Dublin, Ireland.
2022-2
Deprescribing is defined as the planned and supervised process of dose reduction or stopping of medication that might be causing harm, or no longer be of benefit. Barriers to deprescribing include healthcare professional fear and lack of guidance. These may stem from limited available evidence on benefits and harms of deprescribing medications commonly used among older persons. Advances in pharmacoepidemiology and causal inference methods to evaluate comparative effectiveness and safety of prescribing medications have yet to be considered for deprescribing medication. This paper discusses select methods and how they can be applied to deprescribing research, using case studies of benzodiazepines and low-dose acetylsalicylic acid (aspirin). Target trial emulation involves the explicit application of design principles from randomised controlled trials to observational studies. Several design aspects, including defining eligibility criteria and time zero, require additional considerations for deprescribing studies. The active comparator new user design also presents challenges, including selection of an appropriate comparator. This paper discusses these aspects, and others, in relation to deprescribing studies. Furthermore, methods proposed to control for confounding, in particular, the prior event rate ratio and propensity scores, are discussed. Introduction of billing codes or mechanisms for accurately determining when deprescribing has occurred would enhance the ability to conduct research using routinely collected data. Although the approaches discussed in this paper may strengthen observational studies of deprescribing, their use may be best suited to certain scenarios or research questions, where randomised controlled trials may be less feasible.
RESEARCH IN SOCIAL & ADMINISTRATIVE PHARMACY
卷号:18|期号:2|页码:2269-2275
ISSN:1551-7411|收录类别:SSCI
语种
英语
来源机构
Royal College of Surgeons - Ireland; University of Toronto; Womens College Hospital
被引频次(WOS)
4
被引频次(其他)
3
180天使用计数
0
2013以来使用计数
0
EISSN
1934-8150
出版年
2022-2
DOI
10.1016/j.sapharm.2021.05.007
学科领域
循证公共卫生
关键词
Pharmacoepidemiology Causal inference Deprescribing Propensity scores Big data
WOS学科分类
Public, Environmental & Occupational Health Pharmacology & Pharmacy