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

Fulone, Izabela; Silva, Marcus Tolentino; Lopes, Luciane Cruz

doi:10.1136/bmjopen-2017-018956

Cited by 16 publications

(14 citation statements)

References 33 publications

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“…Moreover, healthcare providers may not recommend discontinuing benzodiazepines due to concerns related with withdrawal symptoms, which may occur in up to 50% of patients 38. Our findings are consistent with previous research33 39 40 showing higher prevalence of prescription among women. The increase of benzodiazepine prescription with the number of chronic conditions can be partly explained by poorer quality of sleep and more prevalent anxiety in this group.…”

Section: Discussionsupporting

confidence: 89%

Patterns of benzodiazepine prescription among older adults in Switzerland: a cross-sectional analysis of claims data

Luta

Bagnoud²,

Lambiris

et al. 2020

BMJ Open

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ObjectiveThis study aimed to examine the prevalence and determinants of benzodiazepine prescription among older adults in Switzerland, and analyse association with hospitalisation and costs.DesignRetrospective analysis of claims data.SettingThe study was conducted in nine cantons in Switzerland.ParticipantsOlder adults aged 65 years and older enrolled with a large Swiss health insurance company participated in the study.Primary and secondary outcome measuresThe primary outcome was prevalence of benzodiazepine prescription. The secondary outcomes were (1) determinants of any benzodiazepine prescription; (2) the association between any prescription and the probability of hospitalisation for trauma and (3) the association between any prescription and total healthcare expenditures.ResultsOverall, 69 005 individuals were included in the study. Approximately 20% of participants had at least one benzodiazepine prescription in 2017. Prescription prevalence increased with age (65–69: 15.9%; 70–74: 18.4%; 75–80: 22.5%; >80: 25.8%) and was higher in women (25.1%) compared with men (14.6%). Enrollees with the highest deductible of Swiss Francs (CHF) 2500 were 70% less likely to receive a prescription than enrollees with the lowest deductible of CHF 300 (adjusted OR=0.29, 95% CI 0.24 to 0.35).Individuals with at least one prescription had a higher probability of hospitalisation for trauma (OR=1.31, 95% CI 1. 20 to 1.1.44), and 70% higher health care expenditures (β=0.72, 95% CI 0. 67 to 0.77). Enrollees in canton Valais were three times more likely to receive a prescription compared to enrollees from canton Aargau (OR=2.84, 95% 2.51 to 3.21).ConclusionsThe proportion of older adults with at least one benzodiazepine prescription is high, as found in the data of one large Swiss health insurance company. These enrollees are more likely to be hospitalised for trauma and have higher healthcare expenditures. Important differences in prescription prevalence across cantons were observed, suggesting potential overuse. Further research is needed to understand the drivers of variation, prescription patterns across providers, and trends over time.

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Section: Discussionsupporting

confidence: 89%

Patterns of benzodiazepine prescription among older adults in Switzerland: a cross-sectional analysis of claims data

Luta

Bagnoud²,

Lambiris

et al. 2020

BMJ Open

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“…Prolonged use of benzodiazepines along with antidepressants has also been reported previously in 40% of the study participants [46]. Our ndings showed evidence of long term use of psychotropic and antidementia medications for ≥6 months, although current guidelines stipulate review and withdrawal within 12 weeks [47].…”

Section: Discussionsupporting

confidence: 81%

Person-centered, non-pharmacological intervention in reducing psychotropic medication use among residents with dementia in Australian rural aged care homes

Parajuli

Kuot

Hamiduzzaman

et al. 2020

Preprint

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BackgroundHigh rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with advanced dementia in the ‘Harmony in the Bush Dementia Study’. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold (PLST) and person-centered music intervention.MethodsOur larger study was a quasi-experimental design conducted in five rural nursing homes in Queensland and South Australia. Medication charts (n = 31) were collected retrospectively from three Australian rural aged care facilities through contacting the facility managers before the intervention and after 6 months. Fifty-three staff participated in 31 semi-structured interviews and 8 focus group at post-intervention, and at 1-month and 3-months follow up.ResultsThe median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer’s disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% in the use of at least any psychotropic medication, 19.6% reduction in antipsychotics and benzodiazepines, and 6.5% reduction in antidementia medicines prescription from baseline to at post-intervention, however, these were not statistically significant. There was a decreasing trend in the use of inappropriate use of medications. Psychotropic medications were prescribed up to 43% and antidementia in 45% of participants for more than 6 months. Major themes extracted from qualitative data were reduced/decreased/cessation of medication use, introducing a rest period and the music intervention combined was an alternative approach for medications use, and less behaviors, and ultimately the less use of medications.ConclusionsOur findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications and inappropriate medications in rural nursing homes as supported by findings from both quantitative and qualitative data.Trial registration: ANZCTR, ACTRN12618000263291. Registered on 20th February 2018. http://www.ANZCTR.org.au/ACTRN12618000263291p.aspx).

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“…Furthermore, in the same study, the duration of use exceeded more than 12-week for most of the residents. Prolonged use of benzodiazepines along with antidepressants has also been reported previously in 40% of the study participants [49]. Our ndings showed evidence of long term use of psychotropic and antidementia medications for ≥6 months, although current guidelines stipulate review and withdrawal within 12 weeks [50].…”

Section: Discussionsupporting

confidence: 81%

“…Despite of a reduction trend in the use of psychotropic medicines by implementation of a patient centered NPI approach, our results were not statistically signi cant. Nevertheless, in clinical practice, a nonsigni cant outcome does not always mean the treatment was not clinically effective as small sample sizes had a substantial impact (49). Additionally, another potential reason to support an association of small sample size for the non-signi cant reduction in the use of psychotropic mediations is that all the participating staff in semi-structured interviews and focus group highlighted a less need for medications due to fewer behaviors of the residents.…”

Section: Discussionmentioning

confidence: 99%

Person-centered, non-pharmacological intervention in reducing psychotropic medication use among residents with advanced dementia in Australian rural aged care homes

Parajuli

Kuot

Hamiduzzaman

et al. 2020

Preprint

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BackgroundHigh rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with advanced dementia in the ‘Harmony in the Bush Dementia Study’. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold and person-centered music intervention. MethodsOur larger study was a quasi-experimental design conducted in five rural nursing homes in Queensland and South Australia. Medication charts (n=31) were collected retrospectively from three Australian rural aged care facilities through contacting the facility managers. Medication data for each resident was collected from a three-month medication charts, pre-intervention, and post-intervention. Fifty-three staff participated in 31 semi-structured interviews and 8 focus groups at post-intervention, and at 1-month and 3-months follow up.ResultsThe median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% (n=27) of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer’s disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% (77.4% vs 55%) in the use of at least any psychotropic medication, 19.6% (39% vs, 19.4%) reduction in antipsychotics and benzodiazepines (, 39% vs 19.4%), and 6.5% (42% vs 35.5%) reduction in antidepressants prescription medicines, when comparing residents’ medication charts data covering 3-months pre- and post-intervention However, these changes were not statistically significant, Additionally, there was a decreasing trend in the use of inappropriate use of medications. Psychotropic medications were prescribed in up to 43% and antidementia in 45% of participants for more than 6 months. Major themes extracted from qualitative data were reduced/decreased/cessation of medication use; introducing a rest period and the music intervention combination was an alternative approach for medications use, and resulting in less behaviors, and ultimately the less use of medications. ConclusionsOur findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications and inappropriate medications in rural nursing homes as supported by findings from both quantitative and qualitative data. Trial registration: ANZCTR, ACTRN12618000263291. Registered on 20th February 2018. http://www.ANZCTR.org.au/ACTRN12618000263291p.aspx).

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

Cited by 16 publications

References 33 publications

Patterns of benzodiazepine prescription among older adults in Switzerland: a cross-sectional analysis of claims data

Patterns of benzodiazepine prescription among older adults in Switzerland: a cross-sectional analysis of claims data

Person-centered, non-pharmacological intervention in reducing psychotropic medication use among residents with dementia in Australian rural aged care homes

Person-centered, non-pharmacological intervention in reducing psychotropic medication use among residents with advanced dementia in Australian rural aged care homes

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