Hospital initiation of benzodiazepines and Z-drugs in older adults and discontinuation in primary care

Link to article at PubMed

Res Social Adm Pharm. 2021 Jun 5:S1551-7411(21)00203-5. doi: 10.1016/j.sapharm.2021.06.001. Online ahead of print.


OBJECTIVE: To examine factors associated with continuation of hospital-initiated benzodiazepine receptor agonists (BZRAs) among adults aged ≥65 years, specifically instructions on hospital discharge summaries.

METHODS: This retrospective cohort study involved anonymised electronic record data on prescribing and hospitalisations for 38,229 patients aged ≥65 from forty-four GP practices in Ireland 2011-2016. BZRA initiations were identified among patients with no BZRA prescription in the previous 12 months. Multivariate regression examined whether instructions on discharge messages for hospital-initiated BZRA prescriptions was associated with continuation after discharge in primary care and time to discontinuation.

RESULTS: In total, 418 hospital-initiated BZRAs were identified, 48.8% being to males and mean patient age was 79.0 (SD 8.3) years. Almost 60% of these discharge summarieshad some BZRA instructions (e.g. duration). Approximately 40% (n = 166) were continued in primary care. Lower age, being prescribed a Z-drug or great number of medicines were associated with higher risk of continuation. Of those continued in primary care, in 98 cases (59.6%) the BZRA was discontinued during follow-up (after a mean 184 days). Presence of instructions was associated with higher likelihood of discontinuation (hazard ratio 1.71, 95%CI 1.11-2.62).

CONCLUSIONS: Improved communication to GPs after hospital discharge may be important in avoiding long-term BZRA use.

PMID:34127403 | DOI:10.1016/j.sapharm.2021.06.001

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