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

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  • Additional Information
    • Source:
      Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 7503323 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2125 (Electronic) Linking ISSN: 03065251 NLM ISO Abbreviation: Br J Clin Pharmacol Subsets: MEDLINE
    • Publication Information:
      Publication: Oxford : Wiley-Blackwell
      Original Publication: London, Macmillan Journals Ltd.
    • Subject Terms:
      Polypharmacy* ; Homes for the Aged*/statistics & numerical data; Humans ; Longitudinal Studies ; Female ; Male ; Aged, 80 and over ; Aged ; New South Wales ; Inappropriate Prescribing/statistics & numerical data ; Cohort Studies ; Bayes Theorem ; Dementia/drug therapy ; Nursing Homes/statistics & numerical data
    • Abstract:
      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.)
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    • Grant Information:
      APP1143941 National Health and Medical Research Council; APP1174021 National Health and Medical Research Council; APP2006957 National Health and Medical Research Council
    • Contributed Indexing:
      Keywords: GBTM; polypharmacy; quality indicator programs; residential aged care
    • Publication Date:
      Date Created: 20240826 Date Completed: 20241128 Latest Revision: 20241130
    • Publication Date:
      20241202
    • Accession Number:
      PMC11602946
    • Accession Number:
      10.1111/bcp.16220
    • Accession Number:
      39183449