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Elizabeth A. Bayliss MD MSPH Kathleen Albers MPH Kathy Gleason PhD Lisa E. Pieper MSHA MBA Cynthia M. Boyd MD MPH Noll L. Campbell PharmD MS Kristine E. Ensrud MD MPH Shelly L. Gray PharmD MS Amy M. Linsky MD MSc Derelie Mangin MBChB DPH Lillian Min MD MSHS Michael W. Rich MD Michael A. Steinman MD Justin Turner PhD MClinPharm BPharm Eduard E. Vasilevskis MD MPH Sascha Dublin MD PhD 《Journal of the American Geriatrics Society》2022,70(9):2487-2497
Interpreting results from deprescribing interventions to generate actionable evidence is challenging owing to inconsistent and heterogeneous outcome definitions between studies. We sought to characterize deprescribing intervention outcomes and recommend approaches to measure outcomes for future studies. A scoping literature review focused on deprescribing interventions for polypharmacy and informed a series of expert panel discussions and recommendations. Twelve experts in deprescribing research, policy, and clinical practice interventions participating in the Measures Workgroup of the US Deprescribing Research Network sought to characterize deprescribing outcomes and recommend approaches to measure outcomes for future studies. The scoping review identified 125 papers reflecting 107 deprescribing studies. Common outcomes included medication discontinuation, medication appropriateness, and a broad range of clinical outcomes potentially resulting from medication reduction. Panel recommendations included clearly defining clinically meaningful medication outcomes (e.g., number of chronic medications, dose reductions), ensuring adequate sample size and follow-up time to capture clinical outcomes resulting from medication discontinuation (e.g., quality of life [QOL]), and selecting appropriate and feasible data sources. A new conceptual model illustrates how downstream clinical outcomes (e.g., reduction in falls) should be interpreted in the context of initial changes in medication measures (e.g., reduction in mean total medications). Areas needing further development include implementation outcomes specific to deprescribing interventions and measures of adverse drug withdrawal events. Generating evidence to guide deprescribing is essential to address patient, caregiver, and clinician concerns about the benefits and harms of medication discontinuation. This article provides recommendations and an initial conceptual framework for selecting and applying appropriate intervention outcomes to support deprescribing research. 相似文献
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Dr. David G. Buchsbaum MD MSHA Robin G. Buchanan Roy M. Poses MD Sidney H. Schnoll MD PhD Marcia J. Lawton PhD 《Journal of general internal medicine》1992,7(5):517-521
Objective:To assess the patient and physician characteristics that influence physicians’ detection of problem drinking in their medical
patients.
Setting:The outpatient medical clinic at an urban university teaching hospital staffed by interns and residents.
Design:Cross-sectional study of a rendomly chosen subsample of consecutive patients.
Measurement:Univariate and multivariate analysis with calculated adjusted odds ratios of factors associated with physician detection of
drinking problems. A problem was diagnosed according to the patient’s results on the alcohol module of the Diagnostic Interview
Schedule (DIS).
Results:Physicians detected 22% of 189 presumably inactive problems and 49% of 92 current problems, i.e., those that have occurred
within the preceding year. Multivariate correlates of detection of active problems included male patient gender, presence
of gastrointestinal complications of excessive drinking, number of concurrent medical disorders, and previous medical record
reference to alcohol (p<0.05). Physician gender and year of training were not associated with detection.
Conclusion:Our physicians appear to rely on specific patient characteristics as well as the patient’s medical record to detect drinking
problems in their ambulatory patients. Their reliance upon these factors may hinder their detection of drinking problems in
women patients and less seriously impaired individuals.
Supported in part by Commonwealth Center on Drug Abuse Faculty Grant Program and Bureau of Health Professions, HRSA Grant
for Residency Training in General Internal Medicine. 相似文献
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