{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T03:12:39Z","timestamp":1786677159401,"version":"build-2736575974"},"reference-count":15,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T00:00:00Z","timestamp":1744070400000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Accurately identifying medication discontinuations at scale is important for developing evidence about deprescribing. Gaps in dispensing often serve as proxies for discontinuation but are imprecise. We categorize reasons for gaps in dispensing to inform data\u2010based methods to accurately identify medication discontinuations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using pharmacy dispensing data, we purposively sampled from a population of adults age 65+ with 2+ chronic conditions who experienced a 90\u2010day gap in dispensing\u2014with and without subsequent fills\u2014of oral diabetes drugs, statins, proton pump inhibitors, drugs with anticholinergic properties, anticoagulants and antiplatelet drugs, or antihypertensives. We reviewed clinical documentation (e.g., visit notes, communications, medication orders) from last dispensing through the 90\u2010day gap plus 120\u2009days to classify dispensing gaps as true discontinuations (clinically intended) or non\u2010discontinuations (no evidence of intent to discontinue), and then into subcategories. Medications with no documented explanation for the gap in dispensing and continued listing on the patient's medication list were classified as non\u2010discontinuations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of <jats:italic>N<\/jats:italic>\u2009=\u20091906 records reviewed, there were 1068 (56%) true discontinuations and 838 (44%) non\u2010discontinuations. Subcategories within true discontinuations included provider intent to discontinue, provider substitutions, intentional stops followed by restarts, and agreeing with a colleague's or patient's decision to discontinue. Non\u2010discontinuations included documented low adherence, changes in dose, changes in pharmacy formulary, and changes in drug formulation. Proportions of drugs in categories and subcategories varied by medication group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Using gaps in dispensing as proxy measures for medication discontinuation may introduce bias through misclassification, and varied reasons for discontinuation may complicate causal interpretations.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pds.70142","type":"journal-article","created":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T14:03:44Z","timestamp":1744121024000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Discontinuation Categories Underlying Gaps in Dispensing for Six Medication Groups"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5264-0670","authenticated-orcid":false,"given":"Elizabeth A.","family":"Bayliss","sequence":"first","affiliation":[{"name":"Institute for Health Research Kaiser Permanente Colorado  Aurora Colorado USA"},{"name":"Department of Family Medicine University of Colorado School of Medicine  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenn K.","family":"Goodrich","sequence":"additional","affiliation":[{"name":"Institute for Health Research Kaiser Permanente Colorado  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer C.","family":"Barrow","sequence":"additional","affiliation":[{"name":"Institute for Health Research Kaiser Permanente Colorado  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bill","family":"Harding","sequence":"additional","affiliation":[{"name":"Institute for Health Research Kaiser Permanente Colorado  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney A.","family":"Ripley","sequence":"additional","affiliation":[{"name":"Institute for Health Research Kaiser Permanente Colorado  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney R.","family":"Kraus","sequence":"additional","affiliation":[{"name":"Institute for Health Research Kaiser Permanente Colorado  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie","family":"Paolino","sequence":"additional","affiliation":[{"name":"Institute for Health Research Kaiser Permanente Colorado  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan D.","family":"Norton","sequence":"additional","affiliation":[{"name":"Division of Geriatric Medicine and Gerontology Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orla C.","family":"Sheehan","sequence":"additional","affiliation":[{"name":"Division of Geriatric Medicine and Gerontology Johns Hopkins University School of Medicine  Baltimore Maryland USA"},{"name":"Department of Medicine for the Older Person Connolly Hospital  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda A.","family":"Weffald","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy Kaiser Permanente Colorado  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariel R.","family":"Green","sequence":"additional","affiliation":[{"name":"Division of Geriatric Medicine and Gerontology Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ted E.","family":"Palen","sequence":"additional","affiliation":[{"name":"Institute for Health Research Kaiser Permanente Colorado  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Reeve","sequence":"additional","affiliation":[{"name":"Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Science University of South Australia  Adelaide South Australia Australia"},{"name":"Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew L.","family":"Maciejewski","sequence":"additional","affiliation":[{"name":"Center of Innovation to Accelerate Discovery &amp; Practice Transformation Durham VA Medical Center  Durham North Carolina USA"},{"name":"Department of Population Health Sciences Duke University Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia M.","family":"Boyd","sequence":"additional","affiliation":[{"name":"Division of Geriatric Medicine and Gerontology Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,8]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2015.0324"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e31829b1d2a"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40471\u2010021\u201000264\u20107"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.5366"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/circoutcomes.118.004684"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.5784"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.13063\/2327\u20109214.1049"},{"key":"e_1_2_9_9_1","unstructured":"Centers for Medicare and Medicaid Services Chronic Conditions Data Warehouse https:\/\/www.ccwdata.org\/web\/guest\/home."},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-006-9094-x"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000735"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwq433"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-1508-8187"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2019.1444"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/1077558709359007"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2012-001301"}],"container-title":["Pharmacoepidemiology and Drug Safety"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pds.70142","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T01:57:08Z","timestamp":1745459828000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pds.70142"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":15,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1002\/pds.70142"],"URL":"https:\/\/doi.org\/10.1002\/pds.70142","archive":["Portico"],"relation":{},"ISSN":["1053-8569","1099-1557"],"issn-type":[{"value":"1053-8569","type":"print"},{"value":"1099-1557","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4]]},"assertion":[{"value":"2024-10-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70142"}}