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All about Outcomes: USDeN Panel Weighs in on Defining, Selecting, and Applying Deprescribing Intervention Outcomes

Bayliss, EA, Albers, K, Gleason, K, et al. Recommendations for outcome measurement for deprescribing intervention studies. J Am Geriatr Soc. 2022; 1- 11. doi:10.1111/jgs.17894

The US Deprescribing Research Network’s very own Measures Workgroup recently published recommendations for selecting and using outcomes for deprescribing interventions in the Journal of the American Geriatrics Society. Authors point to discrepancies in outcome definitions as a barrier to high quality evidence on the impact of deprescribing. Inconsistent evidence slows the translation of findings into clinical practice. Through a scoping review of the deprescribing literature, authors identified common outcome measures from 107 deprescribing studies. An expert panel, 12 members from the workgroup with expertise in deprescribing research as well as primary care, geriatrics, pharmacology, and implementation science, convened nine times to discuss outcome measures in the literature. The panel had three goals:

  1. To identify common deprescribing measures and outcome definitions
  2. To prioritize outcome categories for future research
  3. To develop recommendations for defining and operationalizing outcomes

Panelists organized common outcomes into the following categories: medication use, quality of life, functional status, treatment burden, system implementation, adverse drug events, and mortality. They identified adverse drug withdrawal events (ADWEs), treatment burden, and implementation evaluation as high-priority outcome categories to target for further development.

Overall outcomes measurement recommendations included:

  • Medication outcome measures: Select clinically meaningful medication outcomes from reliable data sources and clearly define these measures. Ensure the temporal alignment of the outcome measurement with the intervention.
  • Clinical outcome measures: Select clinically-relevant instruments that are sensitive to change over time. Ensure that samples are sufficiently large and observed for enough time to capture change in outcomes. Minimize the need for self-report instruments.
  • Outcomes needing further development: Develop approaches to capturing ADWEs and treatment burden in studies targeting multiple medications. Adapt implementation assessments to deprescribing interventions by including contextual factors specific to clinical medication management.

Lead author Dr. Liz Bayliss provides the following key takeaways:

“Evidence to guide deprescribing is essential to address patient, caregiver and clinician concerns about the benefits and harms of medication discontinuation. However, deprescribing interventions have used varied definitions of outcome measures, making it difficult to synthesize findings across studies and generate evidence. This paper provides recommendations and an initial conceptual framework to select and use appropriate outcomes for deprescribing interventional studies. Ultimately these recommendations can support high quality deprescribing research.”

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