Evaluation of the prescribing practices of nonbenzodiazepine, benzodiazepine receptor agonist hypnotics in adults at a federally qualified health center

Abstract

ObjectiveTo assess the change in prescribing of nonbenzodiazepine and benzodiazepine receptor agonist hypnotics (Z-drugs) prescribed to adults after U.S. Food and Drug Administration safety warnings. SettingFive clinical sites as part of a Federally Qualified Health Center (FQHC). Practice descriptionVirginia Garcia Memorial Health Center is an FQHC consisting of 5 patient centered medical homes. Practice innovationExamine Z-drug use in a vulnerable adult population to confirm appropriate prescribing and quality care. EvaluationThe primary measure was to determine the percentage of Z-drugs prescribed to patients age 18 years or older during the study period of September 1, 2016, to August 31, 2017. Patients were identified using the electronic health record. Z-drugs included zolpidem, zaleplon, and eszopiclone. Secondary measures included percentage of Z-drug prescribing to adults age 65 years and older, percentage of female patients prescribed zolpidem doses greater than 5 mg, prior behavioral health encounter, and prior pharmacotherapy for insomnia. ResultsOf 22,733 adults age 18 years and older, 282 patients (1.3%) received a Z-drug prescription during the study period. Forty-nine (28.9%) female patients received 10 mg of zolpidem nightly, a zolpidem dose higher than the recommended 5 mg nightly. In addition, of 2239 patients age 65 years and older, 34 patients (1.5%) received a prescription for a Z-drug. ConclusionPrescribing rates of zolpidem in 10-mg doses to female patients were high, indicating that providers could benefit from further education on this topic. In the population, and in adults age 65 years and older, Z-drug prescribing in an FQHC was low compared with available prescribing rates.