Prevalence Of Long-term Use Research Articles

Adverse Effects of Long-Term Oral Corticosteroids in the Department of Dermatology, Antananarivo, Madagascar.

BackgroundLong-term oral corticosteroids have an important role in dermatological care in Madagascar. However, significant adverse effects have been associated with continuous exposure to oral corticosteroids.ObjectiveWe aim to assess the adverse effects of long-term corticosteroid therapy in patients seen in the Department of Dermatology at the University Hospital Joseph Raseta Befelatanana Antananarivo (UH/JRB), Madagascar, and to identify the risk factors associated with these adverse effects.MethodsA cross-sectional study was conducted during 4 months to assess the adverse effects of long-term corticosteroid therapy in patients seen in the Department of Dermatology. Patients treated with oral corticosteroids for more than 3 months were included in our study.ResultsThe prevalence of long-term use of oral corticosteroids in the Department of Dermatology of UH/JRB was 34.28%. A total of 51 patients were included and adverse effects occurred in 64.70% of this population. Repetitive infections and cutaneous adverse reactions were the most frequent adverse effects, in 23.52% and 11.76% of cases, respectively. There were no correlations between age, gender, type of disease treated, the molecule used or daily dose and the risk of adverse effects. Patients who received a corticosteroid dose of more than 40 mg daily (longer than 3 months) or a high cumulative dose of corticosteroids had a high risk of adverse effects.ConclusionRepetitive infections and cutaneous adverse reactions are the most frequent adverse effects of long-term oral corticosteroid use. Prescribing the lowest effective dose may reduce the risk of these adverse effects. Furthermore, prevention of the adverse effects of corticosteroids through diet, calcium and vitamin D supplementation is strongly recommended during long-term oral corticosteroid therapy.

Cost-effectiveness of brief structured interventions to discontinue long-term benzodiazepine use: an economic analysis alongside a randomised controlled trial

Background: In Spain, long-term use of benzodiazepine is prevalent in 7% of the population; however, this longer-term use lacks clinical benefits, costs €90million per year and side-effects further add extra cost through adverse health outcomes. This study aims to estimate the cost-effectiveness of primary care services stepped dose reduction of long-term benzodiazepines using either Structured Interview with Follow-up (SIF) or Without Follow-up (SIW), compared to Treatment as Usual (TAU). Design: Cost-effectiveness analysis was conducted alongside randomised control utilizing data from three arm cluster randomized trial. Setting: Primary care. Participants: 75 general practitioners were randomised to one of the three arms (TAU, SIW, SIF). Measurements: Cost and Cost per Quality-Adjusted Life Year (QALY) Results: Compared to usual care, providing SIW per participant costs an additional €117.94 and adding patient follow-up, €218.4. As a result of intervention, participants showed a gain of, on average, for SIW 0.0144 QALY (95% CI -0.0137 to 0.0425) and for SIF 0.0340 QALYs (0.0069 to 0.0612). The Incremental Cost Effectiveness Ratio was €8190.28/QALY (SIW) and €6423.53/QALY (SIF). At the Spanish reimbursement threshold (€45,000 per QALY) the chance interventions are cost effective is 79.8% for SIW and 97.7% for SIF. Conclusions: Brief structured interventions to discontinue long-term benzodiazepine use represent value for money, particularly with scheduled follow-up appointments, and would represent a cost-effective investment by the Spanish healthcare to reduce prevalence of long-term use.

Cost-effectiveness of brief structured interventions to discontinue long-term benzodiazepine use: an economic analysis alongside a randomised controlled trial.

Background: In Spain, long-term use of benzodiazepine is prevalent in 7% of the population; however, this longer-term use lacks clinical benefits, costs €90million per year and side-effects further add extra cost through adverse health outcomes. This study aims to estimate the cost-effectiveness of primary care services stepped dose reduction of long-term benzodiazepines using either Structured Interview with Follow-up (SIF) or Without Follow-up (SIW), compared to Treatment as Usual (TAU). Design: Cost-effectiveness analysis was conducted alongside randomised control utilizing data from three arm cluster randomized trial. Setting: Primary care. Participants: 75 general practitioners were randomised to one of the three arms (TAU, SIW, SIF). Measurements: Cost and Cost per Quality-Adjusted Life Year (QALY) Results: Compared to usual care, providing SIW per participant costs an additional €117.94 and adding patient follow-up, €218.4. As a result of intervention, participants showed a gain of, on average, for SIW 0.0144 QALY (95% CI -0.0137 to 0.0425) and for SIF 0.0340 QALYs (0.0069 to 0.0612). The Incremental Cost Effectiveness Ratio was €8190.28/QALY (SIW) and €6423.53/QALY (SIF). At the Spanish reimbursement threshold (€45,000 per QALY) the chance interventions are cost effective is 79.8% for SIW and 97.7% for SIF. Conclusions: Brief structured interventions to discontinue long-term benzodiazepine use represent value for money, particularly with scheduled follow-up appointments, and would represent a cost-effective investment by the Spanish healthcare to reduce prevalence of long-term use.

Decreasing Trend in the Use and Long-Term Use of Benzodiazepines Among Young Adults.

Patterns of benzodiazepine (BZD) use and long-term use among young adults are not well known. Our aim was to study trends in BZD use and long-term use among 18-25-year-old young adults by gender and active substance in a nationwide retrospective longitudinal register-based setting. All Finns aged 18-25 years with reimbursed purchases of BZDs in 2006-2014 recorded to the Finnish Prescription Register were included. Annual prevalence rates of BZD use and long-term use among young adults were reported overall, according to gender, drug group (anxiolytic or hypnotic), and active substance. Long-term use of BZDs was defined as purchasing ≥180 Defined Daily Doses (DDDs) in at least two drug purchases during a calendar year. Overall prevalence of BZD use among young adults decreased from 24.0 to 18.8 users per 1000 inhabitants in 2006-2014. Prevalence of long-term use decreased from 5.5 to 3.3 users per 1000 inhabitants. Overall BZD use was higher among females, whereas long-term use was more common among males. Use of anxiolytics was more common than use of hypnotics. Oxazepam, alprazolam, zopiclone, and zolpidem were the most used BZDs, whereas alprazolam and clonazepam were the substances with most long-term use. The use and long-term use of BZDs have decreased annually since 2008 among Finnish young adults. Further research is needed to investigate the reasons behind the decline.

Long-term benzodiazepine use in patients taking antidepressants in a public health setting in Brazil: a cross-sectional study

ObjectiveThe aims of the study were to investigate the prevalence of long-term use of benzodiazepines in patients taking antidepressants and to identify the risk factors associated with the prolonged use...

Long-term use of antipsychotics among community-dwelling persons with Alzheimer׳s disease: A nationwide register-based study

Antipsychotics are recommended only for short-term treatment of severe behavioral and psychological symptoms of dementia. Our objective was to study the duration of antipsychotic use and factors associated with long-term use (365 days or over) among community-dwelling persons with Alzheimer׳s disease (AD) during a 7-year follow-up. This was a nationwide register-based cohort study including all community-dwelling residents in Finland diagnosed with AD in 2005 (n=7217). The follow-up for antipsychotic use started 3 years before the diagnosis of AD and we applied a 7-year washout period to ascertain truly incident antipsychotic use. Follow-up ended on institutionalization, death or at the end of study period (December 31, 2009). Duration of antipsychotic use was modeled from individual purchase histories recorded in the Finnish Prescription Register. During the 7-year follow-up, 34% (2287/6740) of persons initiated antipsychotic use. Median duration of the first antipsychotic use period was 219 (interquartile range 85–583) days. Of those who discontinued antipsychotic use (n=1303), 44% restarted use later. Among users with at least one year of follow-up time after initiating antipsychotic use, prevalence of long-term use was 57% (893/1563). Long-term use was associated with initiation of use after AD diagnosis and choice of antipsychotic. Duration of use was more likely to be shorter among haloperidol users and longer among quetiapine users compared with risperidone users. In conclusion, long-term use of antipsychotics is frequent among community-dwelling persons with AD. Duration of use is not in line with the guidelines recommending time-limited use of antipsychotics.

Prise de benzodiazépines au long cours chez les patients dialysés : une étude descriptive

BackgroundDialysis patients frequently have anxiety and sleeping disorders and that explains a benzodiazepine treatment. A significant proportion of dialysis patients are long-term users even though it is not recommended to take benzodiazepine for more than 3 months. Risks of such a use are well identified. Nephrologists frequently have to prescribe benzodiazepines. This prescription is complex and there are few studies regarding the factors of benzodiazepine use among this population. ObjectivesTo determine the prevalence and the factors related to a long-term benzodiazepine use by dialysis patients. To determine the prevalence and the motivation of patients to stop taking medication among the long-term users who got information about the risk of such a use. MethodThe study includes 91 dialysis chronic patients. Their characteristics were collected from medical records and interviews with the patients. ResultsThe average age of patients is 65,8 years. In all, 50.5% take benzodiazepines. Among benzodiazepine users, the prevalence of long-term use is 78.3%. Long-term benzodiazepine users (a) are older, (b) less active, (c) frequently diabetic, (d) depressive, (e) unable to walk, (f) less often registered on the kidney transplant waiting list, and (g) had less kidney transplant previously. Benzodiazepine doses of long-term users were higher than the doses of short-term users. Moreover, 60% of patients who are chronic users want to take action and stop the treatment. Observation of side effects, impression of ineffectiveness and fear of addiction are the most identified motivation to stop treatment. ConclusionThe prevalence of benzodiazepine chronic use by dialysis patients is high. Giving information to the patient about the use of these molecules seems to have a positive impact on the decision to stop.

Exploring the dark side of the moon: the treatment of benzodiazepine tolerance

The use of benzodiazepines (BZDs) has a history of more than 50 years. The first BZD, chlordiazepoxide, was approved in 1960, primarily to treat anxiety and insomnia. The 1960s saw a rapid diffusion of the use of this drug, followed soon by the still popular diazepam and, gradually, by several others. As early as the 1970s diazepam became the best-selling drug in the UK and the USA [1]. Soon after its introduction, however, reports of BZD tolerance and dependency emerged. BZD tolerance has been reported as early as 1961 [2], but this and other reports during the 1960s and 1970s were obscured by the enthusiastic easy management in the use of these barbiturates replacement drugs. Many countries now have recommendations for a short term use of BZD (2–4 weeks) [1]. Unfortunately these recommendations are largely disregarded by patients and doctors themselves. Misuse of BZD can cause deficits in learning, attention, memory, depression and injurious falls, traffic and other accidents [3]. Overall, the prevalence of long term use in the general population is approximately 2–7.5%, with estimates for long term use among BZD users ranging from 25% to 76% [4]. The problem of use of BZDs is also related to the use of high doses [5–7]. A cross-sectional study with 520 000 patents, estimated that 1.6% used BZDs in very high doses, exceeding the maximal recommended daily dose more than two-fold [8]. Surveys from France, Germany, Italy and the UK showed that 3.9% and 3.2% of current hypnotic and anxiolytic users have been taking a dose higher than the recommended therapeutic range [9]. Few studies evaluated the quality of life in long term users and even less among patients who use BZD at high doses.

Prevalence and trends of benzodiazepine use among Veterans Affairs patients with posttraumatic stress disorder, 2003–2010

BackgroundAlthough the Veterans Affairs and Department of Defense (VA/DoD) clinical guidelines for management of posttraumatic stress disorder (PTSD) recommend against routine benzodiazepine use, little is known about the trends and clinical and prescription profiles of benzodiazepine use since these guidelines were released in 2004. MethodsThis retrospective study included 64,872 patients with a PTSD diagnosis received from care at facilities in VA Northwest Veterans Integrated Service Network (VISN 20) during 2003–2010. Annual prevalence of any use was defined as any prescription for benzodiazepines, and long-term use was defined as >90 days’ supply, in a year. Gender-specific logistic regressions were fit to estimate any and long-term benzodiazepine use, test for linear trends over 8-years and explore factors associated with trends. ResultsThe trend of age-adjusted benzodiazepine use over 8-years rose significantly from 25.0 to 26.8% among men and 31.2 to 38.8% among women. Long-term use in men and women increased from 15.4 to 16.4% and 18.0 to 22.7%, respectively. Comorbid psychiatric and alcohol use disorders (AUD) were associated with a greater increase in long-term use of benzodiazepines. In 2010, 61% of benzodiazepine users received >90 days’ supply. Among those prescribed benzodiazepines long-term, 11% had AUD and 47% were also prescribed opioids long-term. ConclusionDespite VA/DoD clinical guidelines recommending against routine use of benzodiazepines for PTSD, the adjusted prevalence of long-term use increased among men and women with PTSD in VISN 20. Widespread concomitant use of benzodiazepines and opioids suggests risk management systems and research on the efficacy and safety of these medications are needed.

Identifying Clinically Questionable Psychotropic Prescribing Practices for Medicaid Recipients in New York State

This study sought to identify and characterize rates of clinically questionable prescribing in New York State. As part of a quality improvement initiative, 34 national psychopharmacology experts identified a set of questionable prescribing practices recognizable from pharmacy claims data. Indicators of such practices were applied to Medicaid claims data for 217,216 beneficiaries in New York State who had an active psychotropic prescription on April 1, 2008. A total of 156,103 (72%) of these beneficiaries had one or more continuing (>90 days) prescriptions for a psychotropic. About 10% of adults were prescribed four or more psychotropics concurrently, and 13% of children and 2% of older adults were prescribed three or more concurrently. Prescribing an antipsychotic with a moderate-to-high risk of causing metabolic abnormalities approached 50% (46%) among individuals who had existing cardiometabolic conditions. Among beneficiaries prescribed second-generation antipsychotics with a moderate-to-high risk of causing metabolic abnormalities, over half (60%) had not received a metabolic screening test in the past year. Among women of reproductive age prescribed mood stabilizers, over one-quarter (30%) were prescribed a valproic acid-based formulation despite its potential for teratogenicity. Only 2% of youths under age 18 were prescribed benzodiazepines; however, about half (48%) had trials over 90 days' duration. Examination of pharmacy claims from Medicaid beneficiaries in New York State indicated that prescribing practices deemed clinically questionable by pharmacology experts are common. Aggregated pharmacy claims data can identify such practices, and reviews of these data can be a core component of efforts to improve prescribing practices.

Identifying Clinically Questionable Psychotropic Prescribing Practices for Medicaid Recipients in New York State

Identifying Clinically Questionable Psychotropic Prescribing Practices for Medicaid Recipients in New York State

Trends in prescribed opioid therapy for non-cancer pain for individuals with prior substance use disorders

Long-term opioid therapy for non-cancer pain has increased. Caution is advised in prescribing for persons with substance use disorders, but little is known about actual health plan practices. This paper reports trends and characteristics of long-term opioid use in persons with non-cancer pain and a substance abuse history. Using health plan data (1997–2005), the study compared age–sex-standardized rates of incident, incident long-term and prevalent long-term prescription opioid use, and medication use profiles in those with and without substance use disorder histories. The CONsortium to Study Opioid Risks and Trends study included adult enrollees of two health plans, Kaiser Permanente of Northern California (KPNC) and Group Health Cooperative (GH) of Seattle, Washington. At KPNC (1999–2005), prevalence of long-term use increased from 11.6% to 17.0% for those with substance use disorder histories and from 2.6% to 3.9% for those without substance use disorder histories. Respective GH rates (1997–2005), increased from 7.6% to 18.6% and from 2.7% to 4.2%. Among persons with an opioid disorder, KPNC rates increased from 44.1% to 51.1%, and GH rates increased from 15.7% to 52.4%. Long-term opioid users with a prior substance abuse diagnosis received higher dosage levels, were more likely to use Schedule II and long-acting opioids, and were more often frequent users of sedative-hypnotic medications in addition to their opioid use. Since these patients are viewed as higher risk, the increased use of long-term opioid therapy suggests the importance of improved understanding of the benefits and risks of opioid therapy among persons with a history of substance abuse, and the need for more careful screening for substance abuse history than is the usual practice.

Cataract in older women exposed to hormone replacement

In 2003–2004 there were 6 712 407 surgical procedures performed on the NHS in England, of which 457 382 (6.8%) were ophthalmological and 298 404 (4.4%) were cataract operations. The mean age of cataract surgery patients was 75 years and 62% were female, indicating that around 185 000 cataract operations were performed in older women during the year.1 The prevalence of current Hormone Replacement Therapy (HRT) use among women in England aged 45–64 years in 1992 was 15%, with the prevalence of long-term use being 10%.2 Women who were using HRT just over a decade ago will now have reached an age where many can be expected to be requiring cataract surgery. A full understanding of both the health benefits and risks of HRT use requires a knowledge of short- and long-term desired and unwanted effects. Age-related cataract mostly develops over a period of years with multifactorial personal, socioeconomic, dietary, lifestyle, environmental, health, and genetic risk factors having been implicated for nuclear, cortical, and posterior subcapsular cataract.3, 4, 5, 6, 7, 8, 9, 10

Use of hypnotic and tranquillising drugs in general practice

In the Netherlands, as in other countries, the prevalence of long-term use of benzodiazepines is high. There was a high correlation between long-term use of benzodiazepines on the one hand and age and psychic condition on the other. The use was much higher in women than in men. Health problems were mentioned most (patient's view) as causing the use. Objective r - r To know more about the characteristics of long-term users of hypnotic and tranquillising drugs in a primary health care area in The Netherlands. Design r - r A questionnaire was applied to users of benzodiazepines and the computerised medical records were analysed. Setting r - r Nine general practices affiliated to the Registration Network Family Practices (RNH) of the University of Maastricht (UM). Subjects r - r A sample of 506 users, aged U 30 years, was divided into four categories: short-term (<3 months) users (once-only and episodic) and long-term users (episodic and continuous). Results r - r In 1992/93, 81% were long-term users and 42% of these took their drug continuously. All groups investigated had a preponderance of women. Health problems more so than social problems led to use of the drug. Long-term use was associated with older age, depressive behaviour in handling problems, a higher score on the medicine addiction index, problems with children or housing, and satisfaction with the effects of the drug. Conclusion r - r Most people taking benzodiazepines are long-term users. Age, depressive behaviour, addiction, satisfaction and problems with children or housing are risk factors for long-term use. Gender is not risk factor.

Prevalence of long-term use of medicines with prolonged oral clearance in the elderly: a survey in north east England

Prevalence of long-term use of medicines with prolonged oral clearance in the elderly: a survey in north east England

Prevalence of long-term use of medicines with prolonged oral clearance in the elderly: a survey in north east England.

To determine the prevalence of long-term use by the elderly of prescribed and over-the-counter (OTC) medicines with prolonged oral clearance (POC), with regard to sugars content, dose form and therapeutic groups of medicines used. Two cross-sectional observational surveys in ten general medical practices in north-east England during 1996. Computerised patient records of all elderly patients (aged 60 years and over) were surveyed for prescribed medicines use. Within these practices, 50% of elderly patients registered with ten general medical practitioners were surveyed by postal questionnaire to assess over-the-counter (OTC) medicines use. Of 20,731 elderly patients registered, prevalence of use of prescribed prolonged oral clearance (POC) medicines was 9.8% (95% CI: 8.2%, 11.3%) and use in females aged 75 years and older was significantly more likely (P < 0.0001). Of 2,796 prescribing instances (PIs) for 143 POC medicines used long-term, 53% were gastrointestinal and 72% were sugars-free; however, 82% of 542 PIs for generic liquids were sugars-containing compared with 8% of 685 PIs for proprietary liquid oral medicines. Of 1,532 elderly respondents to a postal questionnaire, 17 were using 13 different OTC medicines with POC regularly and long-term (mean prevalence; 1.1%). Of the 17 instances of regular long-term use of OTC medicines, 59% were sugars-free. Prescribed medicines represent the bulk of regular, long-term medicines use in the elderly. Generic prescribing is more likely to result in sugars-containing medicines being dispensed. Generic medicines manufacturers must be encouraged to provide sugars-free alternatives to POC medicines used long-term, and health professionals should be vigilant when prescribing and dispensing these medicines to the increasingly dentate elderly.

Hormone replacement therapy: patterns of use studied through British general practice computerized records.

We aimed to describe the longitudinal pattern of hormone replacement therapy (HRT) consumption in a cohort of long-term users (defined as use for >1 year). We carried out longitudinal analysis of prescription data derived from GPs' computer records. Subjects were recruited through 15 general practices in the former Oxford, South West and North West Thames Regions that contributed to the VAMP/OPCS general practice research database. All women in the practices aged 45-64 years in September 1991 were identified. Of these, the analysis concerned the 1224 long-term users and 1154 non-user controls who remained in the practices from September 1991 to March 1995; 868 (71%) of the users and 698 (61%) of the controls also provided questionnaire data. The prevalence of HRT use was 15% in 1992, a rise of 16% from 1991. The prevalence of long-term use was 10%; 22% of the cohort identified as taking HRT between April and September 1991 had left the practices or were not taking HRT 1 year later. But for the group defined as long-term users in 1992, the rate of discontinuation was less than 5% per year over the following 2 1/2 years. Users of opposed therapy were 50% more likely to discontinue than users of unopposed therapy. Almost all women who had or had not undergone hysterectomy were taking unopposed or opposed therapy, respectively. Over 80% of prescriptions were for oral therapy. A third of users of either opposed or unopposed therapy changed the formulation during the 4 years of observation, and two-thirds of those who used both forms changed at least once in addition. Two changes were required to accommodate 94% of users. Once women have taken HRT for a year, their continuation rate is over 95% per annum. Although the majority of women stayed with one formulation, a substantial minority changed formulation quite frequently, three formulations being required to accommodate 94% of long-term users over 4 years. Any trial of HRT use will need to recruit long-term users and allow for change in formulation of HRT in its protocol.

The risk of liver neoplasia in relation to combined oral contraceptive use

Benign liver tumors occurring in young women were rarely reported in the medical literature before the introduction of oral contraceptives in the early 1960s. Subsequently, there were numerous case reports from the U.S. and other countries of liver tumors in women who used combined oral contraceptives. These reports, coupled with data from two U.S. case-control studies, indicate that the risk of hepatocellular adenoma increases sharply with increasing duration of oral contraceptive use. Case reports suggest that there may be a similar effect on the risk of focal nodular hyperplasia, but this is not established because there have been no case-control studies of the lesion. The incidence of benign liver disease attributable to oral contraceptive use in the U.S. is small because of the very low incidence of the disease. There have also been numerous case reports of malignant liver tumors in young women who used oral contraceptives. Seven case-control studies have been conducted — two in Great Britain, two in the U.S., one in Italy, one in several developing countries (conducted by the World Health Organization (WHO)), and one in South Africa. Data from the first five studies, all conducted in low risk populations, indicated an association of hepatocellular carcinoma (largely in the absence of liver cirrhosis) with oral contraceptive use. Because of small numbers estimates were unstable, but the risk did not appear to be increased appreciably for durations of use less than about five years. For longer durations, the risk appeared increased by five- to tenfold or more. There was little evidence of hepatitis B infection in the cases, but systematic determinations were not carried out. An increased risk of cholangiocarcinoma was not established, but few of these lesions were studied. Because the incidence of primary liver cancer in Northern Europe and the U.S. is low, the incidence attributable to oral contraceptive use is also likely to be low. The WHO study was carried out in eight countries, most of which have a high incidence of liver cancer and a high prevalence of a predisposing factor, hepatitis B infection. Similarly, the South African study was carried out among black women, and virtually all of the cases had serological evidence of hepatitis B infection. Both studies indicated no association of short-term oral contraceptive use with risk of hepatocellular carcinoma, and the WHO study indicated a lack of association with cholangiocarcinoma. The prevalence of longterm use was too low for informative analysis. Future studies will be needed to assess whether long durations of oral contraceptive use increase the risk of liver cancer in countries in which both hepatitis B infection and liver cancer are common.