Analysis of longitudinal patterns and predictors of medicine use in residential aged care using group-based trajectory modelling: The MEDTRAC-Polypharmacy longitudinal cohort study.

Autor: Wabe N; Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia., Urwin R; Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia., Seaman K; Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia., Timothy A; Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia., Raban MZ; Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia., Westbrook J; Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia.
Jazyk: angličtina
Zdroj: British journal of clinical pharmacology [Br J Clin Pharmacol] 2024 Aug 25. Date of Electronic Publication: 2024 Aug 25.
DOI: 10.1111/bcp.16220
Abstrakt: Aims: Polypharmacy serves as a quality indicator in residential aged care facilities (RACFs) due to concerns about inappropriate medication use. However, aggregated polypharmacy rates at a single time offer limited value. Longitudinal analysis of polypharmacy patterns provides valuable insights into identifying potential overuse of medicines. We aimed to determine long-term trajectories of polypharmacy (≥9 medicines) and factors associated with each polypharmacy trajectory group.
Methods: This was a longitudinal cohort study using electronic data from 30 RACFs in New South Wales, Australia. We conducted group-based trajectory modelling to identify and characterize polypharmacy trajectories over 3 years. We evaluated the model fitness using the Bayesian Information Criterion, entropy (with a value of ≥0.8 considered ideal) and several other metrics.
Results: The study included 2837 permanent residents (median age = 86 years, 61.7% female and 47.4% had dementia). We identified five polypharmacy trajectory groups: group 1 (no polypharmacy, 46.0%); group 2 (increasing polypharmacy, 9.4%); group 3 (decreasing polypharmacy, 9.2%); group 4 (increasing-then decreasing polypharmacy, 10.0%), and group 5 (persistent polypharmacy, 25.4%). The model showed excellent performance (e.g., entropy = 0.9). Multinomial logistic regressions revealed the profile of each trajectory group (e.g., group 5 residents had higher odds of chronic respiratory disease compared with group 1).
Conclusions: Our study identified five polypharmacy trajectory groups, including one with over a quarter of residents following a persistently high trajectory, signalling concerning medication overuse. Quality indicator programs should adopt tailored metrics to monitor diverse polypharmacy trajectory groups, moving beyond the current one-size-fits-all approach and better capturing the evolving dynamics of residents' medication regimens.
(© 2024 The Author(s). British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.)
Databáze: MEDLINE
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