Hospital initiation of benzodiazepines and Z-drugs in older adults and discontinuation in primary care
Objective To examine factors associated with continuation of hospital-initiated benzodiazepine receptor agonists (BZRAs) among adults aged ≥65 years, specifically instructions on hospital discharge summaries.
Methods This retrospective cohort study involved anonymised electronic record data on prescribing and hospitalisations for 38,229 patients aged ≥65 from forty-four GP practices in Ireland 2011-2016. BZRA initiations were identified among patients with no BZRA prescription in the previous 12 months. Multivariate regression examined whether instructions on discharge messages for hospital-initiated BZRA prescriptions was associated with continuation after discharge in primary care and time to discontinuation.
Results Most BZRA initiations occurred in primary care, however the rate of hospital-initiated BZRAs was higher. Almost 60% of 418 hospital initiations had some BZRA instructions (e.g. duration) on the discharge summary. Approximately 40% (n=166) were continued in primary care. Lower age, being prescribed a Z-drug or great number of medicines were associated with higher risk of continuation. Of those continued in primary care, in 98 cases (59.6%) the BZRA was discontinued during follow-up (after a mean 184 days). Presence of instructions was associated with higher likelihood of discontinuation (hazard ratio 1.67, 95%CI 1.09-2.55).
Conclusions Improved communication to GPs after hospital discharge may be important in avoiding long-term BZRA use.
Health Research Board (HRB) through the HRB Centre for Primary Care Research (grant no. HRC/2014/01)
CommentsThe original article is available at https://www.medrxiv.org Published version is available in Research in Social and Administrative Pharmacy doi: 10.1016/j.sapharm.2021.06.001 and RCSI repository https://hdl.handle.net/10779/rcsi.14938896.v1
Published CitationColl S, Walsh ME, Fahey T, Moriarty F. Hospital initiation of benzodiazepines and Z-drugs in older adults and discontinuation in primary care. medRxiv 2020
Publication Date27 Jul 2020
- General Practice
- HRB Centre for Primary Care Research
- School of Pharmacy and Biomolecular Sciences
- Population Health and Health Services
PublisherCold Spring Harbor Laboratory
- Submitted Version (Preprint)