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Wang C, Wang X, Wang J, Li X, Lu D, Guo F, Yao Y, Zhu J, Shen C, Xie Q, Mao H, Zhang P, Yang X, Wu H, Lv Q, Yi Z. Prevalence and clinical correlates of benzodiazepine use in the patients with major depressive disorder. J Affect Disord 2024:S0165-0327(24)01200-X. [PMID: 39043307 DOI: 10.1016/j.jad.2024.07.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/09/2024] [Accepted: 07/17/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) is a serious and disabling condition characterized by abnormal mood changes. Clinical guidelines for depression treatment recommend antidepressant medications, with benzodiazepines acting as short-term synergists. However, little is currently known about the prevalence and associated clinical risk factors of benzodiazepine use among Chinese patients with MDD. This study aimed to explore the prevalence and clinical risk factors associated with benzodiazepine use in this population. METHODS A total of 2742 patients with MDD (males/females = 816/1926, aged 14-60 years) participated in this cross-sectional observational study. General information and psychosis assessments were collected online. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), anxiety symptoms using the Generalized Anxiety Disorder-7 (GAD-7), and sleep problems and suicidal tendencies using the third and ninth items of the PHQ-9. Multivariable logistic regression analysis models were employed to identify factors associated with benzodiazepine use. RESULTS The prevalence of benzodiazepine use among patients with MDD was 42.9 %. Among these patients, 99.6 % used a single benzodiazepine, with oxazepam being the most frequently prescribed. Age, severity of sleep problems, depressive symptoms, and anxiety symptoms were significantly correlated with benzodiazepine use (all P < 0.001). LIMITATIONS The cross-sectional design of this study precludes establishing causal relationships. CONCLUSION Our findings indicate a high prevalence of benzodiazepine use among Chinese patients with MDD. Factors such as severe depressive symptoms, anxiety symptoms, age, and sleep problems appear to be associated with benzodiazepine use. These results underscore the importance of vigilance regarding benzodiazepine use in patients with MDD.
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Affiliation(s)
- Chongze Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Xiaoxiao Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, No. 12 Wulumuqi Road (middle), Shanghai 200040, China
| | - Jinde Wang
- Shanghai Fengxian District Mental Health Center, Shanghai 201418, China
| | - Xin Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, No. 12 Wulumuqi Road (middle), Shanghai 200040, China
| | - Daofeng Lu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, No. 12 Wulumuqi Road (middle), Shanghai 200040, China
| | - Fang Guo
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, No. 12 Wulumuqi Road (middle), Shanghai 200040, China
| | - Yuan Yao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, No. 12 Wulumuqi Road (middle), Shanghai 200040, China
| | - Jiayu Zhu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, No. 12 Wulumuqi Road (middle), Shanghai 200040, China
| | - Chengjia Shen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, No. 12 Wulumuqi Road (middle), Shanghai 200040, China
| | - Qingfang Xie
- Shanghai Baoshan District Mental Health Center, Shanghai 201900, China
| | - Haiying Mao
- Shanghai Baoshan District Mental Health Center, Shanghai 201900, China
| | - Peiyun Zhang
- Nantong Fourth People's Hospital, Nantong 226005, Jiangsu, China
| | - Xiaolong Yang
- Taicang Third People's Hospital, Taicang 215488, Jiangsu, China
| | - Haisu Wu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.
| | - Qinyu Lv
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, No. 12 Wulumuqi Road (middle), Shanghai 200040, China.
| | - Zhenghui Yi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, No. 12 Wulumuqi Road (middle), Shanghai 200040, China; Institute of Mental Health, Fudan University, Shanghai 200040, China.
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Nissan R, Kurzweil E, Haj-Yahia A, Ashorov N, Hershkovitz A. Hypnotic drug use and rehabilitation outcomes in post-acute geriatric hip fracture patients: A retrospective study. Injury 2024; 55:111606. [PMID: 38834012 DOI: 10.1016/j.injury.2024.111606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 06/06/2024]
Abstract
INTRODUCTION The use of hypnotic drugs is common in the elderly and is associated with negative health outcomes. Our aim was to evaluate the prevalence of hypnotic drug usage amongst hip fracture patients undergoing a rehabilitation program and investigate any potential associations between hypnotic drug use and rehabilitation outcomes in a post-acute care setting. METHODS A retrospective analysis of 440 geriatric hip fracture patients was conducted from 1/1/2019 to 12/2021 in a geriatric rehabilitation center. The main outcome measures were the Functional Independence Measure (FIM), the motor FIM effectiveness and length of stay (LOS). RESULTS Two hundred and twenty-eight (51.7 %) patients out of the entire cohort (440)), were prescribed hypnotic drugs. These patients exhibited a significantly lower rate of diabetes (p = 0.025), a higher rate of depression (p = 0.003), and lower albumin levels (p = 0.023) upon admission to rehabilitation in comparison to untreated patients. No significant differences were observed between the two patient groups in functional rehabilitation outcomes or LOS. Moreover, no correlation was established between the hypnotic drug burden during rehabilitation and the outcome measures. Furthermore, no significant differences were found between patients treated with hypnotic drugs on admission and those who were prescribed these drugs during rehabilitation. The type of hypnotic drug did not affect these results. CONCLUSION The use of hypnotic drugs by elderly individuals undergoing a rehabilitation program after a hip fracture is unlikely to have an adverse impact on their short-term rehabilitation outcomes. Consequently, there may not be an immediate necessity to discontinue these drugs upon admission. Nevertheless, the use of hypnotic drugs should be approached with caution and minimized whenever possible due to an increased fall risk and other adverse effects.
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Affiliation(s)
- Ran Nissan
- Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel; Division of Clinical Pharmacy, Institute for Drug Research, School of Pharmacy, The Hebrew University of Jerusalem, Israel
| | - Erez Kurzweil
- Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel
| | - Aseel Haj-Yahia
- Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel
| | - Nina Ashorov
- Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel
| | - Avital Hershkovitz
- Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel; Faculty of Medicine and Health Sciene, Tel-Aviv University, Tel Aviv, Israel.
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Park J, Engstrom G, Ouslander JG. Prescribing Benzodiazepines and Opioids and Clinical Characteristics Associated With 30-Day Hospital Return in Patients Aged ≥75 Years: Secondary Data Analysis. J Gerontol Nurs 2024; 50:25-33. [PMID: 38569101 DOI: 10.3928/00989134-20240312-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
PURPOSE The current study compared prevalence of opioid or benzodiazepine (BZD) prescription and co-prescription of opioids and BZD at discharge and return to a community hospital within 30 days, as well as identified clinical characteristics associated with hospital return in patients aged ≥75 years. METHOD A secondary analysis of a database created during implementation of the Safe Transitions for At Risk Patients program at a 400-bed community teaching hospital in south Florida was conducted. Multivariable logistic regression analyses were performed to identify significant demographic and clinical characteristics associated with return to the hospital within 30 days of discharge. RESULTS A total of 24,262 participants (52.6% women) with a mean age of 85.3 (SD = 6.42) years were included. More than 20% in each central nervous system prescription group (i.e., opioids only, BZD only, opioids and BZD) returned to the hospital within 30 days of discharge. Demographic and chronic conditions (e.g., congestive heart failure, chronic obstructive pulmonary disease, diabetes) and poly-pharmacy were significant factors of a 30-day return to the hospital. CONCLUSION Findings highlight the importance of hospital nurses' role in identifying high-risk patients, educating patients and caregivers, monitoring them closely, communicating with primary care physicians and specialists, and conducting intensive follow up via telephone to avoid 30-day rehospitalization. [Journal of Gerontological Nursing, 50(4), 25-33.].
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Gozda K, Leung J, Baum L, Singer A, Konrad G, McMillan DE, Falk J, Kosowan L, Leong C. Insights into patient characteristics and documentation of the use of sedative-hypnotic/anxiolytics in primary care: a retrospective chart review study. BMC PRIMARY CARE 2022; 23:111. [PMID: 35538427 PMCID: PMC9087974 DOI: 10.1186/s12875-022-01724-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/25/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Despite the known safety risks of long-term use of sedative-hypnotic/anxiolytic medications, there has been limited guidance for the safe and effective use of their chronic use in a primary care clinic setting. Understanding the characteristics of patients who receive sedative-hypnotic/anxiolytic medication and the clinical documentation process in primary care is the first step towards understanding the nature of the problem and will help inform future strategies for clinical research and practice.
Objectives
Characterize patients who received a sedative-hypnotic/anxiolytic prescription in primary care, and (2) gain an understanding of the clinical documentation of sedative-hypnotic/anxiolytic indication and monitoring in electronic medical records (EMR).
Methods
A random selection of patients who received a prescription for a benzodiazepine or Z-drug hypnotic between January 2014 and August 2016 from four primary care clinics in Winnipeg were included. Data was collected retrospectively using the EMR (Accuro®). Patient variables recorded included sex, age, comorbidities, medications, smoking status, and alcohol status. Treatment variables included drug type, indication, pattern of use, dose, adverse events, psychosocial intervention, tapering attempts, social support, life stressor, and monitoring parameters for sedative-hypnotic use. Demographic and clinical characteristics were described using descriptive statistics.
Results
Records from a sample of 200 primary care patients prescribed sedative-hypnotic/anxiolytics were analyzed (mean age 55.8 years old, 61.5% ≥ 65 years old, 61.0% female). Long-term chronic use (≥ 1 year) of a sedative-hypnotic/anxiolytic agent was observed in 29.5% of the sample. Zopiclone (30.7%) and lorazepam (28.7%) were the most common agents prescribed. Only 9.5% of patients had documentation of a past tapering attempt of their sedative-hypnotic/anxiolytic. The most common indications for sedative-hypnotic/anxiolytic use recorded were anxiety (33.0%) and sleep (18.0%), but indication was undetermined for 57.0% of patients. Depression (33.5%) and falls (18.5%) were reported by patients after the initiation of these agents.
Conclusions
A higher proportion of females and users 65 years and older received a prescription for a sedative-hypnotic/anxiolytic, consistent with previous studies on sedative-hypnotic use. We found inconsistencies in the documentation surrounding sedative-hypnotic/anxiolytic use. The indication for their use was unclear in a large number of patients. These findings will help us understand the state of the problem in primary care and inform future strategies for clinical research.
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Cucciare MA, Hagedorn HJ, Bounthavong M, Abraham TH, Greene CJ, Han X, Kemp L, Marchant K, White P, Humphreys K. Promoting benzodiazepine cessation through an electronically-delivered patient self-management intervention (EMPOWER-ED): Randomized controlled trial protocol. Contemp Clin Trials Commun 2022; 29:100994. [PMID: 36111174 PMCID: PMC9468353 DOI: 10.1016/j.conctc.2022.100994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022] Open
Abstract
Background Long-term benzodiazepine dependence carries significant health risks which might be reduced with low-cost patient self-management interventions. A booklet version of one such intervention (Eliminating Medications Through Patient Ownership of End Results; EMPOWER) proved effective in a Canadian clinical trial with older adults. Digitizing such an intervention for electronic delivery and tailoring it to different populations could expand its reach. Accordingly, this article describes the protocol for a randomized controlled trial to test the effectiveness of an electronically-delivered, direct-to-patient benzodiazepine cessation intervention tailored to U.S. military veterans. Methods Design: Two-arm individually randomized controlled trial. Setting US Veterans Health Administration primary care clinics. Participants Primary care patients taking benzodiazepines for three or more months and having access to a smartphone, tablet or desktop computer. Intervention and comparator Participants will be randomized to receive either the electronically-delivered EMPOWER (EMPOWER-ED) protocol or asked to continue to follow provider recommendations regarding their benzodiazepine use (treatment-as-usual). Measurements The primary outcomes are complete benzodiazepine cessation and 25% dose reduction, assessed using administrative and self-report data, between baseline and six-month follow-up. Secondary outcomes are self-reported anxiety symptoms, sleep quality, and overall health and quality of life, measured at baseline and 6-month follow-up, and benzodiazepine cessation at 12-month follow-up. Comments This randomized controlled trial will evaluate whether the accessibility and effectiveness of a promising intervention for benzodiazepine cessation can be improved through digitization and population tailoring.
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Affiliation(s)
- Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA.,Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72205, USA.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Hildi J Hagedorn
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, 55417, USA.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, 55454, USA
| | - Mark Bounthavong
- Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, 94025, USA.,Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, 94025, USA
| | - Traci H Abraham
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA.,Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72205, USA.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Carolyn J Greene
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.,Translational Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Xiaotong Han
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA.,Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72205, USA.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Lakiesha Kemp
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
| | - Kathy Marchant
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
| | - Penny White
- Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72205, USA
| | - Keith Humphreys
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, 94025, USA.,Department of Psychiatry, Stanford University, Stanford, CA, 94305, USA
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Cucciare MA, Abraham TH, Kemp L, White P, Marchant K, Hagedorn HJ, Humphreys K. Adapting the Eliminating Medications Through Patient Ownership of End Results Protocol to Promote Benzodiazepine Cessation Among US Military Veterans: Focus Group Study With US Military Veterans and National Veterans Health Administration Leaders. J Med Internet Res 2022; 24:e35514. [PMID: 36121697 PMCID: PMC9531005 DOI: 10.2196/35514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 07/21/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Long-term dependence on prescribed benzodiazepines is a public health problem. Eliminating Medications Through Patient Ownership of End Results (EMPOWER) is a promising self-management intervention, delivered directly to patients as a printed booklet, that is effective in promoting benzodiazepine reduction and cessation in older adults. EMPOWER has high potential to benefit large health care systems such as the US Veterans Health Administration (VHA), which cares for many veterans who use benzodiazepines for extended periods. Objective We aimed to adapt the original EMPOWER booklet materials for electronic delivery and for use among US military veterans receiving VHA care who were long-term benzodiazepine users. Methods We used elements of Analysis, Design, Development, Implementation, and Evaluation, a framework commonly used in the field of instructional design, to guide a qualitative approach to iteratively adapting EMPOWER Electronic Delivery (EMPOWER-ED). We conducted 3 waves of focus groups with the same 2 groups of VHA stakeholders. Stakeholders were VHA-enrolled veterans (n=16) with medical chart evidence of long-term benzodiazepine use and national VHA leaders (n=7) with expertise in setting VHA policy for prescription benzodiazepine use and developing electronically delivered educational tools for veterans. Qualitative data collected from each wave of focus groups were analyzed using template analysis. Results Themes that emerged from the initial focus groups included veterans’ anxiety about self-tapering from benzodiazepines and prior negative experiences attempting to self-taper without support. Participants also provided feedback on the protocol’s look and feel, educational content, the tapering protocol, and website functionality; for example, feedback from policy leaders included listing, on the cover page, the most commonly prescribed benzodiazepines to ensure that veterans were aware of medications that qualify for self-taper using the EMPOWER-ED protocol. Both groups of stakeholders identified the importance of having access to supportive resources to help veterans manage sleep and anxiety in the absence of taking benzodiazepines. Both groups also emphasized the importance of ensuring that the self-taper could be personalized and that the taper instructions were clear. The policy leaders emphasized the importance of encouraging veterans to notify their provider of their decision to self-taper to help facilitate provider assistance, if needed, with the taper process and to help prevent medication stockpiling. Conclusions EMPOWER-ED is the first direct-to-patient electronically delivered protocol designed to help US military veterans self-taper from long-term benzodiazepine use. We used the Analysis, Design, Development, Implementation, and Evaluation framework to guide the successful adaption of the original EMPOWER booklet for use with this population and for electronic delivery. The next step in this line of research is to evaluate EMPOWER-ED in a randomized controlled trial.
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Affiliation(s)
- Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, United States.,Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Traci H Abraham
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, United States.,Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Lakiesha Kemp
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, United States
| | - Penny White
- Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Kathy Marchant
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, United States
| | - Hildi J Hagedorn
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Keith Humphreys
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.,Department of Psychiatry, Stanford University, Menlo Park, CA, United States
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Part I: Interactive case: Rational deprescribing of benzodiazepine receptor agonists for insomnia. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Meraya AM, Banji OJ, Khobrani MA, Alhossan A. Evaluation of psychotropic medications use among elderly with psychiatric disorders in Saudi Arabia. Saudi Pharm J 2021; 29:603-608. [PMID: 34194267 PMCID: PMC8233536 DOI: 10.1016/j.jsps.2021.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 04/13/2021] [Indexed: 12/02/2022] Open
Abstract
AIMS Potentially inappropriate psychotropic medications (PIPMs) prescribed to older adults with psychiatric disorders can inadvertently affect their health. The use of standards and guidelines can ensure prudent prescribing and minimize the risk of morbidities. This study assessed the pattern and prevalence of prescription of PIPMs to older individuals in outpatient psychiatric settings in Saudi Arabia, using the updated 2015 Beers criteria, as well as the probability of polypharmacy. METHODS The study was conducted in the outpatient psychiatric clinics of the only psychiatric hospital in Jazan region of Saudi Arabia. A retrospective cross-sectional review of electronic medical records was undertaken during 2018 to assess PIPM use and psychotropic polypharmacy. Descriptive statistics were generated and associations between PIPM use and baseline characteristics were assessed using multivariable logistic regression. RESULTS Overall, 68% of 1300 older adults received PIPMs, and 77.7% were on psychotropic polypharmacy. Amitriptyline, chlorpromazine, and trifluoperazine were extensively prescribed. Paroxetine (1.2%) and benzodiazepines were prescribed to a smaller proportion of the patients. Elderly with schizophrenia (AOR = 0.046, p < 0.001) and anxiety (AOR = 0.530, p = 0.036) were significantly less likely to have PIPMs than those with dementia. Likewise, elderly with depression and anxiety were less likely to have psychotropic polypharmacy as compared to those with dementia. CONCLUSION A substantial number of the elderly received PIPMs possibly based on implicit criteria. It is therefore important to provide mental health care providers in the region with educational programs to increase their awareness of PIPMs.
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Affiliation(s)
- Abdulkarim M. Meraya
- Department of Clinical Pharmacy, Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Saudi Arabia
| | - Otilia J.F. Banji
- Department of Clinical Pharmacy, Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Saudi Arabia
| | - Moteb A. Khobrani
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Saudi Arabia
| | - Abdulaziz Alhossan
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Saudi Arabia
- Corporate of Pharmacy Services, King Saud University Medical City, Saudi Arabia
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The prevalence and prescribing patterns of benzodiazepines and Z-drugs in older nursing home residents in different European countries and Israel: retrospective results from the EU SHELTER study. BMC Geriatr 2021; 21:277. [PMID: 33902474 PMCID: PMC8077828 DOI: 10.1186/s12877-021-02213-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/06/2021] [Indexed: 11/11/2022] Open
Abstract
Background Benzodiazepines (BZDs) and Z-drugs have high potential for developing frequent adverse drug events in older adults (e.g., psychomotor sedation, drug-related dementia, deliria, drug dependence, etc.). Knowledge of the prevalence and patterns of the use of BZDs/Z-drugs in vulnerable older patients is important in order to prevent and reduce the burden caused by their drug-related complications. Our study focused on international comparisons of the prevalence, country-specific prescribing patterns and risk factors of regular BZD/Z-drug use in nursing home (NH) residents. Methods This cross-sectional study retrospectively analysed data of 4156 NH residents, prospectively assessed in the Services and Health in the Elderly in Long TERm care (SHELTER) project conducted from 2009 to 2014. Residents aged 65+ in 57 NHs in 7 European countries and Israel were assessed by the InterRAI Long-Term Care Facilities instrument. Descriptive statistics and multiple logistic regression models were used to describe the country-specific prevalence, patterns and risk factors of BZD/Z-drug use. Results The mean age of the participants was 83.4 ± 9.4 years, 73% were female and 27.7% used BZDs/Z-drugs. The prevalence of BZD/Z-drug use differed significantly across countries, ranging from 44.1% in Israel to 14.5% in Germany. The most frequently prescribed were zopiclone (17.8%), lorazepam (17.1%) and oxazepam (16.3%). Lorazepam, oxazepam and diazepam were used in most of the countries. Brotizolam, temazepam and zolpidem showed highest prevalence in Israel (99.4% of all regular users of this medication in the sample), the Netherlands (72.6%) and France (50.0%), respectively. Residing in Israel was the most significant factor associated with the use of BZDs/Z-drugs or BZDs only (odds ratio [OR] 6.7; 95% confidence interval [CI] 4.8–9.2 and OR 9.7, 95%CI 6.5–14.5, respectively). The use of Z-drugs only was most significantly associated with residing in France (OR 21.0, 95%CI 9.0–48.9). Conclusions Despite global recommendations and warnings, the preference for and extent of use of individual BZDs and Z-drugs in vulnerable NH residents differ significantly across countries. The strong association with country of residence compared to clinical and functional factors denotes that prescribing habits, social, cultural, behavioural, and regulatory factors still play an important role in the current diverse use of these medications. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02213-x.
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Ashworth N, Kain N, Wiebe D, Hernandez-Ceron N, Jess E, Mazurek K. Reducing prescribing of benzodiazepines in older adults: a comparison of four physician-focused interventions by a medical regulatory authority. BMC FAMILY PRACTICE 2021; 22:68. [PMID: 33832432 PMCID: PMC8034172 DOI: 10.1186/s12875-021-01415-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 03/14/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The inappropriate and/or high prescribing of benzodiazepine and 'Z' drugs (BDZ +) is a major health concern. The purpose of this study was to determine whether physician or pharmacist led interventions or a simple letter or a personalized prescribing report from a medical regulatory authority (MRA) was the most effective intervention for reducing BDZ + prescribing by physicians to patients 65 years of age or older. METHODS This was a four-armed, one year, blinded, randomized, parallel-group, investigational trial in Alberta, Canada. Participants were fully licensed physicians (n = 272) who had prescribed 4 times the defined daily dose (4 + DDD) or more of any BDZ + to an older patient at least once in the 3rd quarter of 2016. All physician-participants were sent a personalized prescribing profile by the MRA. They were then randomized into four groups that received either nothing more, an additional personal warning letter from the MRA, a personal phone call from an MRA pharmacist or a personal phone call from an MRA physician. The main outcomes were prescribing behavior change of physicians at one year in terms of: change in mean number of older patients receiving 4 + DDD BDZ + and mean dose BDZ + prescribed per physician. To adjust for multiple statistical testing, we used MANCOVA to test both main outcome measures simultaneously by group whilst controlling for any baseline differences. RESULTS All groups experienced a significant fall in the total number of older patients receiving 4 + DDD of BDZ + by about 50% (range 43-54%) per physician at one year, and a fall in the mean dose of BDZ + prescribed of about 13% (range 10-16%). However, there was no significant difference between each group. CONCLUSIONS A personalized prescribing report alone sent from the MRA appears to be an effective intervention for reducing very high levels of BDZ + prescribing in older patients. Additional interventions by a pharmacist or physician did not result in additional benefit. The intervention needs to be tested further on a more general population of physicians, prescribing less extreme doses of BDZ + and that looks at more clinical and healthcare utilization outcomes.
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Affiliation(s)
- Nigel Ashworth
- Department of Medicine, University of Alberta, Edmonton, Canada.
- Research and Evaluation Unit, College of Physicians and Surgeons of Alberta, 10020-100 Street NW, Edmonton, AB, 2700T5J 0N3, Canada.
| | - Nicole Kain
- Department of Medicine, University of Alberta, Edmonton, Canada
- Research and Evaluation Unit, College of Physicians and Surgeons of Alberta, 10020-100 Street NW, Edmonton, AB, 2700T5J 0N3, Canada
| | - Delaney Wiebe
- Research and Evaluation Unit, College of Physicians and Surgeons of Alberta, 10020-100 Street NW, Edmonton, AB, 2700T5J 0N3, Canada
| | - Nancy Hernandez-Ceron
- Research and Evaluation Unit, College of Physicians and Surgeons of Alberta, 10020-100 Street NW, Edmonton, AB, 2700T5J 0N3, Canada
| | - Ed Jess
- Research and Evaluation Unit, College of Physicians and Surgeons of Alberta, 10020-100 Street NW, Edmonton, AB, 2700T5J 0N3, Canada
| | - Karen Mazurek
- Research and Evaluation Unit, College of Physicians and Surgeons of Alberta, 10020-100 Street NW, Edmonton, AB, 2700T5J 0N3, Canada
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11
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Schmitz A. Benzodiazepines: the time for systematic change is now. Addiction 2021; 116:219-221. [PMID: 32335948 DOI: 10.1111/add.15095] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Allison Schmitz
- Clinical Pharmacy Specialist-Mental Health, Fargo VA Health Care System, Fargo, ND, USA
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12
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Liao YH, Chen LY, Liao KM, Chen CY. Drug Safety of Benzodiazepines in Asian Patients With Chronic Obstructive Pulmonary Disease. Front Pharmacol 2021; 11:592910. [PMID: 33424603 PMCID: PMC7793820 DOI: 10.3389/fphar.2020.592910] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/27/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: Many comorbidities, including depression, anxiety, and insomnia, occur in patients with chronic obstructive pulmonary disease (COPD). These patients may be prescribed benzodiazepines (BZDs). However, there are some concerns that benzodiazepines increase the risk of drug overdose, hypercapnic respiratory failure, acute exacerbation and increased mortality. The aim of our study was to evaluate the drug safety of BZDs in patients with COPD. Methods: We used the National Health Insurance Research database in Taiwan from 2002 to 2016 to perform a retrospective cohort study. We enrolled patients who were exposed to the first prescription of BZDs, non-BZDs or a combination (mix user) after COPD diagnosis. We performed 1:1:1 propensity score matching in three groups. The outcomes were COPD with acute exacerbation and all-cause mortality. Poisson regression analysis was performed to evaluate the incidence rate ratios for the outcomes in the groups. Results: After propensity score matching, there were 2,856 patients in each group. After adjusting for confounding factors, we found that compared to BZD users, non-BZD and mix users had nonsignificant differences in outpatient management of acute exacerbations, hospitalization management of acute exacerbations, emergency department management of acute exacerbations and all-cause mortality. BZD and mix groups showed significantly increased admission for acute exacerbation of COPD compared with that of the nonuser group, with IRRs of 2.52 (95% CI, 1.52-4.18; p = 0.0004) and 2.63 (95% CI, 1.57-4.40; p = 0.0002), respectively. Conclusion: BZD, non-BZD, and mix users showed increased COPD-related respiratory events compared to nonusers in Asian subjects.
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Affiliation(s)
- Yi-Hsiang Liao
- Department of Traditional Chinese Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Liang-Yu Chen
- Master Program in Clinical Pharmacy, School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Tainan, Taiwan
| | - Chung-Yu Chen
- Master Program in Clinical Pharmacy, School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan
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13
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Smichenko J, Gil E, Zisberg A. Relationship Between Changes in Sedative-Hypnotic Medications Burden and Cognitive Outcomes in Hospitalized Older Adults. J Gerontol A Biol Sci Med Sci 2020; 75:1699-1705. [PMID: 31942612 DOI: 10.1093/gerona/glaa015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Sedative-hypnotic medications (SHMs) are frequently used in hospitalized older patients, despite undesirable effects on cognitive status. Although previous studies found a significant number of patients experience changes in SHM use during hospitalization, it is unclear which pattern of change leads to hospital-associated cognitive decline (HACD). This study tested the association between patterns of SHM change and HACD. METHODS This secondary analysis study included 550 patients age 70+ who were cognitively intact at admission (Short Portable Mental Status Questionnaire [SPMSQ] ≥8). HACD was defined as at least 1-point decline in SPMSQ between admission and discharge. Changes in sedative burden (SB) before and during hospitalization (average SB of all hospitalization days) were coded using the Drug Burden Index sorting study participants into four groups: without SB (n = 254), without SB changes (n = 132), increased SB (n = 82), and decreased SB (n = 82). RESULTS Incidence of HACD was 233/550 (42.4%). In multivariate logistic analysis controlling for demographic characteristics, length of stay, severity of acute illness, comorbidity, SB score at home, pain on admission and depression, the odds of HACD were 2.45 (95% CI: 1.16 to 5.13) among participants with increased SB, 2.10 (95% CI: 1.13 to 3.91) among participants without SB changes, compared with participants with decreased SB. CONCLUSION Older patients whose SB is increased or does not change are at higher risk for acquired cognitive decline than are those whose SB is reduced. Identifying patients with a potential increase in SB and intervening to reduce it may help to fight HACD.
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Affiliation(s)
- Juliana Smichenko
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Mount Carmel, Haifa, Israel
| | - Efrat Gil
- Clalit Health Services, Haifa and West Galilee and Carmel Hospital, Haifa, Israel.,Faculty of Medicine, Technion, Haifa, Israel
| | - Anna Zisberg
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Mount Carmel, Haifa, Israel
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14
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Madruga CS, Paim TL, Palhares HN, Miguel AC, Massaro LTS, Caetano R, Laranjeira RR. Prevalence of and pathways to benzodiazepine use in Brazil: the role of depression, sleep, and sedentary lifestyle. ACTA ACUST UNITED AC 2018; 41:44-50. [PMID: 30328968 PMCID: PMC6781701 DOI: 10.1590/1516-4446-2018-0088] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 04/12/2018] [Indexed: 12/21/2022]
Abstract
Objective: This study aimed to determine the prevalence of benzodiazepine (BZD) use in Brazil and to investigate the direct and indirect effects of alcohol consumption, sedentary lifestyle (SL), depressive symptoms (DS), and sleep dissatisfaction (SD) on BZD use. Methods: The Second Brazilian Alcohol and Drugs Survey (II BNADS) used stratified cluster probabilistic sampling to select 4,607 individuals aged 14 years and older from the Brazilian household population. Results: The lifetime and 12-month prevalence of BZD use was 9.8 and 6.1%, respectively. Older participants (age 40 and older) and women had higher rates. Alcohol use disorder, DS, and SD were significantly more prevalent in BZD users. The parallel multiple mediator model showed a positive direct effect of alcohol consumption on BZD use, with significant positive indirect effects of SL, SD, and DS as simultaneous mediators leading to higher BZD intake. Other statistically significant indirect pathways were DS alone, SD alone, and all of the above except SL. Conclusion: The prevalence of BZD use in Brazil is high compared to that of other countries. Knowledge of the main risk factors and pathways to consumption can guide prevention initiatives and underlie the development of better tailored and effective treatment strategies.
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Affiliation(s)
- Clarice S Madruga
- Instituto Nacional de Ciência e Tecnologia para Políticas Públicas do Álcool e Outras Drogas (INPAD), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Departamento de Psiquiatria, UNIFESP, São Paulo, SP, Brazil
| | - Thales L Paim
- Instituto Nacional de Ciência e Tecnologia para Políticas Públicas do Álcool e Outras Drogas (INPAD), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Departamento de Psiquiatria, UNIFESP, São Paulo, SP, Brazil
| | - Hamer N Palhares
- Instituto Nacional de Ciência e Tecnologia para Políticas Públicas do Álcool e Outras Drogas (INPAD), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Andre C Miguel
- Instituto Nacional de Ciência e Tecnologia para Políticas Públicas do Álcool e Outras Drogas (INPAD), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Departamento de Psiquiatria, UNIFESP, São Paulo, SP, Brazil
| | - Luciana T S Massaro
- Instituto Nacional de Ciência e Tecnologia para Políticas Públicas do Álcool e Outras Drogas (INPAD), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Departamento de Psiquiatria, UNIFESP, São Paulo, SP, Brazil
| | | | - Ronaldo R Laranjeira
- Instituto Nacional de Ciência e Tecnologia para Políticas Públicas do Álcool e Outras Drogas (INPAD), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Departamento de Psiquiatria, UNIFESP, São Paulo, SP, Brazil
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15
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16
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Shadmi E. Healthcare disparities amongst vulnerable populations of Arabs and Jews in Israel. Isr J Health Policy Res 2018; 7:26. [PMID: 29789022 PMCID: PMC5963169 DOI: 10.1186/s13584-018-0226-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/09/2018] [Indexed: 11/30/2022] Open
Abstract
The complex nature of studying health and healthcare disparities in general, and in the context of the Israeli healthcare system in particular, is depicted in two recent IJHPR articles. The first examines Emergency Department (ED) waiting times in a tertiary children’s hospital and the second examines disparities in the health care for people with schizophrenia of an ethnic-national minority. Contrary to other Israeli studies on wide disparities in health and healthcare, these studies show no disparities - ED waiting times did not differ among Arab and Jewish children and report no differences in performance of Hemoglobin A1C tests or in surgical interventions in patients with cardiovascular disease between Arabs and Jews with schizophrenia. Thus, the studies reflect areas of equitable health care delivery within the Israeli healthcare system. Future studies should account for the fact that the phenomena of health and healthcare disparities is complex and should utilize rigorous methodologies to take into consideration the various factors that may affect the manifestation of differences amongst population groups. As a result, they may help detect disparities which may otherwise be missed.
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Affiliation(s)
- Efrat Shadmi
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel. .,Department of Health Policy Planning and the Clalit research Institute, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel.
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Capsule Commentary on Steinman et al., Epidemic Use of Benzodiazepines among Older Adults in Israel: Epidemiology and Leverage Points for Improvement. J Gen Intern Med 2017; 32:919. [PMID: 28516326 PMCID: PMC5515796 DOI: 10.1007/s11606-017-4075-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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