Abstract
Hospitalisation influences drug therapy in ambulatory care and this influence is generally negatively perceived. The few studies that have explored changes in benzodiazepine or sleep medication use as a function of hospitalisation failed to precisely determine the hospital's role in initiating, continuing and discontinuing these drugs on a valid basis. The aim of the study was to ascertain the overall influence of hospitalisation on the prescription of benzodiazepines and Z-drugs in outpatient care with a special focus on the role of different hospital departments and drug classes. In a secondary data analysis, we used prescription data for 181 037 patients who visited 127 hospitals and compared the numbers of patients with prescriptions of benzodiazepines and Z-drugs 50 days before and 50 or 100 days after hospitalisation. The proportion of patients who received benzodiazepines or Z-drugs increased from 3.1% before admission to 3.6% at 50 days after discharge and fell to the former level after an additional 50 days. A multivariable logistic regression showed that gender and department had an additional impact on these results. Of those patients without a prescription for a benzodiazepine or Z-drug before admission, 0.6% received a prescription in both time-windows after discharge. Of those patients who were prescribed a benzodiazepine, 38.0% received short-acting substances and 40.3% received long-acting substances before hospitalisation. After hospitalisation, these rates changed to favour short-acting substances (44.4% and 34.4%, respectively). The hospital effect on initiating and increasing hypnotic or sedative drug use seems to be only moderate and temporary. A change in favour of short-acting substances is even welcome. In less than 1% of patients, the hospital initiated the continuous use of benzodiazepines and Z-drugs, which may put pressure on primary care physicians. However, the widespread use of these drugs in hospitals does not seem to be continued on a large scale in primary care.
Highlights
Benzodiazepines are often prescribed to treat anxiety and sleep problems even though they can have serious adverse effects, such as craving, withdrawal symptoms upon discontinuation and increased falls, especially in long-term use [1,2,3] and in elderly patients [4, 5]
In less than 1% of patients, the hospital initiated the continuous use of benzodiazepines and Z-drugs, which may put pressure on primary care physicians
Statistical analysis To study the effect of hospitalisation, we modelled the probability of receiving a prescription of hypnotics and/or sedatives in primary care before and after a hospital stay, using a three-factorial design with interactions and covariates
Summary
Benzodiazepines are often prescribed to treat anxiety and sleep problems even though they can have serious adverse effects, such as craving, withdrawal symptoms upon discontinuation and increased falls, especially in long-term use [1,2,3] and in elderly patients [4, 5]. An interview study performed in Belgian nursing homes showed that nurses do not avoid using benzodiazepines and view their use as an adequate method for addressing their residents’ sleeping problems [8]. Sedative drugs were initiated in more than one third of patients admitted to an internal ward of a Swiss hospital, most of them naïve to these drugs [11]
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