van Hulten R, Teeuw K B, Bakker A B, Bakker A, Leufkens H G
Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, The Netherlands.
Pharm World Sci. 2000 Jun;22(3):96-101. doi: 10.1023/a:1008749220107.
The relationship between characteristics of benzodiazepine exposure and health-status was examined in order to investigate risk profiles of benzodiazepine users. In the only pharmacy of a Dutch community of 13,500 inhabitants, all current benzodiazepine users that presented with a benzodiazepine prescription in November 1994 were invited to participate. On the basis of the RAND-36 questionnaire, summary scores for both physical and mental health were calculated, the Physical Component Summary (PCS) and the Mental Component Summary (MCS). After dichotomization with a cut-off point indicating seriously impaired health and after the combination of the PCS and MCS, four different categories of health status could be identified. We used logistic regression to study the relation between these four different groups with respect to benzodiazepine exposure. In total a group of 360 current benzodiazepine users was studied. Results showed that almost one-third of the participants had no significant impaired health; this group was further classified as reference group. We classified three other groups: one with physical problems (31%), one with mental problems (18%), and one with a combination of the two (22%). Multivariate analysis showed differences in risk factors for an impaired health status. The group with impaired physical health was associated with self-reported indication for muscle relaxation, hypnotic use, and a high CDS (Chronic Disease Score). The group with impaired mental health was associated with more frequent consulting of a mental health care specialist and with a low sense of self-efficacy. The group with both impaired physical as well as mental health was associated with a higher incidence of widowhood, a lower sense of self-efficacy, a high CDS, using benzodiazepines more than prescribed, and reporting depression as reason for their benzodiazepine use. In particular, two groups need critical examination: a group of apparently healthy users with long-term benzodiazepine use; and a frail group with impaired physical and mental health and using a higher dose than prescribed. Patient counseling and management of these four groups can be tailored to the specific needs of each group.
为了调查苯二氮䓬类药物使用者的风险特征，研究人员对苯二氮䓬类药物暴露特征与健康状况之间的关系进行了研究。在荷兰一个拥有13500名居民的社区的唯一一家药房中，所有在1994年11月开具了苯二氮䓬类药物处方的当前使用者都被邀请参与研究。根据兰德36项问卷，计算了身体健康和心理健康的汇总分数，即身体成分汇总（PCS）和心理成分汇总（MCS）。在以表明健康严重受损的临界点进行二分法划分，并将PCS和MCS相结合之后，可以确定四种不同的健康状况类别。我们使用逻辑回归来研究这四个不同组与苯二氮䓬类药物暴露之间的关系。总共研究了360名当前苯二氮䓬类药物使用者。结果显示，近三分之一的参与者健康状况没有明显受损；该组被进一步分类为参照组。我们将其他三组分类如下：一组有身体问题（31%），一组有心理问题（18%），一组有两者的组合（22%）。多变量分析显示了健康状况受损的风险因素存在差异。身体健康受损的组与自我报告的肌肉松弛指征、催眠药使用以及高慢性病评分（CDS）相关。心理健康受损的组与更频繁地咨询心理健康护理专家以及低自我效能感相关。身体和心理健康均受损的组与丧偶发生率较高、自我效能感较低、高CDS、超量使用苯二氮䓬类药物以及将抑郁作为使用苯二氮䓬类药物的原因相关。特别是，有两组需要重点检查：一组是长期使用苯二氮䓬类药物但表面健康的使用者；另一组是身体和心理健康受损且使用剂量高于处方规定的体弱组。可以根据每组的具体需求对这四组患者进行咨询和管理。
