Benzodiazepine and z-hypnotic prescribing from acute psychiatric inpatient discharge to long-term care in the community

Abstract

Background:Benzodiazepine and z-hypnotic prescribing has slowly decreased over the past 20 years, however long-term chronic prescribing still occurs and is at odds with prescribing guidance.Objectives:To identify the pattern of benzodiazepine and z-hypnotic prescribing in psychiatric inpatients at discharge and 12 months post-discharge.Methods:Retrospective observational longitudinal cohort study of patients admitted to two adult psychiatric wards between June and November 2012 (inclusive) who were discharged with a prescription for a benzodiazepine or z-hypnotic drug. Routinely collected prescription data available from NHS Scotland Prescribing Information System was used to identify and follow community prescribing of benzodiazepine and z-hypnotics for a 12 month period post-discharge. Data were entered in Excel® and further analysed using SPSS 23. Ethical approval was not required for this service evaluation however Caldicott Guardian approval was sought and granted.Results:Eighty patients were admitted during the study period however only those patients with a single admission were included for analysis (n=74). Thirty per cent (22/74) of patients were prescribed a benzodiazepine or z-hypnotics at discharge; 14 of whom received ‘long-term’ benzodiazepine and z-hypnotics i.e. continued use over the 12 month period. Seven patients received a combination of anxiolytics and hypnotics (e.g., diazepam plus temazepam or zopiclone). Long-term use was associated with a non-significant increase in median benzodiazepine or z-hypnotic dose, expressed as diazepam equivalents.Conclusions:One in three patients were prescribed a benzodiazepine or z-hypnotics at discharge with 1 in 5 receiving continuous long-term treatment (prescriptions) for 12 months post-discharge. As chronic long-term B-Z prescribing and use still remains an issue, future strategies using routine patient-level prescribing data may support prescribers to review and minimise inappropriate long-term prescribing.

Long-term benzodiazepine prescriptions in community psychiatry clinics

“…Approximately one out of every four patients (23.8%) in the Johannesburg Health District community psychiatric clinics were prescribed a benzodiazepine. While similar high prescribing rates of 18.7% -24.0% have been reported, 10,32,38 lower rates of 3.8% -12.6% have also been reported. 13,14,15 The variation in reported prescribing rates could be because of 32 , the high prescribing rates may have been because the prescription was initiated during hospital admission and continued in the community clinics where the studies were conducted soon after discharge.…”

“…While similar high prescribing rates of 18.7% -24.0% have been reported, 10,32,38 lower rates of 3.8% -12.6% have also been reported. 13,14,15 The variation in reported prescribing rates could be because of 32 , the high prescribing rates may have been because the prescription was initiated during hospital admission and continued in the community clinics where the studies were conducted soon after discharge. The high prescribing rates in this study may in part be because of clinicians' lack of knowledge of benzodiazepine prescribing guidelines, 39 a lack of capacity and time for the re-evaluation of benefits and risks associated with benzodiazepines, 40 and failure to provide patient psychoeducation on non-pharmacological interventions to manage symptoms.…”

Feasibility and utility of enhanced sleep management on in-patient psychiatry wards

“…Those issued hypnotics while on a psychiatry ward in the UK will typically remain on them at discharge, with a substantial percentage still using them at 12 months. 19 A recent review of the side-effects and benefits of a range of hypnotics highlights the limited evidence base of antihistamines in particular, and the potential for dependency. There is also a falls risk in the elderly.…”

Medicines reconciliation at the community mental health team–general practice interface: quality improvement study

“…Interestingly, 31% (52/166) of all discrepancies were associated with long-term B-Zs. This may be due to multiple factors: B-Z being initiated during a crisis or admission, 29 poor communication between primary and secondary care, 28 fragmented care 30 and health carer factors, 16 as well as a lack of structured medicines reconciliation and/or proactive medicines review when patients attend their CMHTs or GP. 31 Long-term prescribing of B-Zs is also a concern, as they are known to worsen cognitive impairment 32 and depressive symptoms 33,34 and reduce the efficacy of some psychological therapies, 35 and are associated with increased mortality for people with schizophrenia.…”