Initiation of benzodiazepines in the elderly after hospitalization.
ABSTRACT To estimate the rate of new chronic benzodiazepine use after hospitalization in older adults not previously prescribed with benzodiazepines.
Retrospective cohort study using linked, population-based administrative data.
Ontario, Canada between April 1, 1992 and March 31, 2005.
Community-dwelling seniors who had not been prescribed benzodiazepine drugs in the year before hospitalization were selected from all 1.4 million Ontario residents aged 66 years and older.
New chronic benzodiazepine users, defined as initiation of benzodiazepines within 7 days after hospital discharge and an additional claim within 8 days to 6 months. We used multivariate logistic regression to examine for the effect of hospitalization on the primary outcome after adjusting for confounders.
There were 405,128 patient hospitalizations included in the cohort. Benzodiazepines were prescribed to 12,484 (3.1%) patients within 7 days of being discharged from hospital. A total of 6,136 (1.5%) patients were identified as new chronic benzodiazepine users. The rate of new chronic benzodiazepine users decreased over the study period from 1.8% in the first year to 1.2% in the final year (P < .001). Multivariate logistic regression found that women, patients admitted to the intensive care unit or nonsurgical wards, those with longer hospital stays, higher overall comorbidity, a prior diagnosis of alcoholism, and those prescribed more medications had significantly elevated adjusted odds ratios for new chronic benzodiazepine users. Older individuals had a lower risk for the primary outcome.
New benzodiazepine prescription after hospitalization occurs frequently in older adults and may result in chronic use. A systemic effort to address this risky practice should be considered.
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ABSTRACT: To determine the prevalence of benzodiazepine (BZD) prescription and the factors related to prescribing them in the elderly in the community, in an acute general hospital (AH) and in a convalescence geriatric unit (CGU). Retrospective study of 334 CGU inpatients discharged from an AH. A comprehensive geriatric assessment included functional and cognitive evaluation before hospitalization, at admission and at discharge from CGU (Barthel index, Lawton index and Folstein Mini-Mental State Examination), as well as comorbidity (Charlson index), polypharmacy and social situation. The percentage of benzodiazepine prescriptions at the different healthcare levels was compared and their related factors were evaluated (Chi-squared test). The prevalence of benzodiazepine prescriptions in the community was 23.6%, and being female and polypharmacy were related factors to prescribing at this level. During AH admission, this proportion increased up to 38.6%, and after CGU admission decreased to 21.,9%. Factors related to prescription in AH were, being female, polypharmacy and osteoarticular-fracture related diagnosis, and in CGU, being female and polypharmacy. The prevalence of benzodiazepine prescribing was high among elderly people at every healthcare level (community, AH and CGU), and polypharmacy was one of the significant factors associated with prescribing. This prescribing was increased during AH admission due to a medical or surgical process.Revista Española de Geriatría y Gerontología 10/2013;
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ABSTRACT: Hospitals in Canada manage their formularies independently, yet many inpatients are discharged on medications which will be purchased through publicly-funded programs. We sought to determine how much public money could be saved on chronic medications if hospitals promoted the initiation of agents with the lowest outpatient formulary prices. We used administrative databases for the province of Ontario to identify patients initiated on a proton pump inhibitor (PPI), angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) following hospital admission from April 1(st) 2008-March 31(st) 2009. We assessed the cost to the Ontario Drug Benefit Program (ODB) over the year following initiation and determined the cost savings if prescriptions were substituted with the least expensive agent in each class. The cost for filling all PPI, ACE inhibitor and ARB prescriptions was $ 2.48 million, $968 thousand and $325 thousand respectively. Substituting the least expensive agent could have saved $1.16 million (47%) for PPIs, $162 thousand (17%) for ACE inhibitors and $14 thousand (4%) for ARBs over the year following discharge. In a setting where outpatient prescriptions are publicly funded, harmonising outpatient formularies with inpatient therapeutic substitution resulted in modest cost savings and may be one way to control rising pharmaceutical costs.PLoS ONE 06/2012; 7(6):e39737. · 3.53 Impact Factor
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ABSTRACT: BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) may receive benzodiazepines for a variety of reasons, including as treatment for insomnia, as treatment for depression and anxiety, and to help relieve refractory dyspnoea. However, benzodiazepines have been linked to adverse physiological respiratory outcomes in individuals with COPD. The potential adverse respiratory effects of benzodiazepines in COPD may also be heightened in older adults given their altered pharmacokinetics that increase benzodiazepine half-life. There is minimal information on the scope and nature of benzodiazepine use in the older adult COPD population. OBJECTIVE: The purpose of this study was to describe patterns of benzodiazepine use among older adults with COPD. METHODS: A validated algorithm was applied to Ontario healthcare administrative data to identify older adults with COPD. Incident oral benzodiazepine receipt between 1 April 2004 and 31 March 2009, defined as no benzodiazepines dispensed in the year prior to incident prescription, was examined. Regression techniques were used to identify patient characteristics associated with new benzodiazepine use. Descriptive statistics were performed to describe benzodiazepine use among new users. The analysis was stratified by COPD severity defined by COPD exacerbation frequency (less severe COPD: 0 exacerbations in the year prior; more severe COPD: 1 or more exacerbations in the year prior). RESULTS: Among 111,445 older adults with COPD, 35,311 (31.7 %) received a new benzodiazepine. New benzodiazepine receipt was higher among individuals with more severe COPD (adjusted odds ratio 1.43, 95 % CI 1.38-1.48). Among new benzodiazepine users, there was a relatively high frequency of receipt of long-acting agents (14.6 %), dispensations for greater than 30 days (32.6 %), second dispensations (22.0 % or 30.6 % for occurrence within 120 % or 200 % days of the index prescription, respectively), early refills (11.6 %), and benzodiazepine receipt during COPD exacerbations (9.0 %). Among individuals with more severe COPD, 35.4 % of incident use occurred during a COPD exacerbation. CONCLUSIONS: Almost one-third of older individuals with COPD received a new benzodiazepine, and rates were higher among those with more severe COPD. Important safety and quality of care issues are potentially raised by the degree and pattern of benzodiazepine use in this older and respiratory-vulnerable population.Drugs & Aging 02/2013; · 2.50 Impact Factor