a Department of Internal Medicine and Nephrology , Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale , Bellinzona , Switzerland.
b Quality and Patient Safety Service , La Carità Hospital, Ente Ospedaliero Cantonale , Locarno , Switzerland.
Postgrad Med. 2018 Sep;130(7):627-636. doi: 10.1080/00325481.2018.1504594. Epub 2018 Aug 2.
Reducing the inappropriate benzodiazepine (BZD) prescriptions represents a challenge for health care systems worldwide. The 'Choosing Wisely' campaign recommends against the use of BZD in the elderly as the first choice for insomnia, agitation, or delirium. We aimed to determine whether a transparent monitoring-benchmarking together with educational interventions, on top of the internal publication of a targeted recommendation, could be effective in curbing BZD prescriptions.
Multicenter before and after study in a network of five southern-Switzerland teaching hospitals. An intervention based on a transparent continuous monitoring-benchmarking system, called 'Reporting Wisely', able to collect, analyze, and report data on BZD prescriptions and educational interventions focused on themed meetings, audit, and feedback, was implemented. The intervention was limited to the Internal Medicine. The impact of the intervention on new BZD prescriptions and de-prescribing at hospital discharge, was assessed using segmented regression analyses of interrupted time-series and comparing Internal Medicine to Surgery.
Between July 12014, and June 302017, data of 45,597 hospital admissions, from Internal Medicine and Surgery departments were analyzed. Before the intervention (July 12014 to December 312015), the mean monthly new BZD prescription rate was 7.2%; value dropping to 5.5% (24% relative reduction; p < 0.001) in the intervention phase (January 12016 to June 302017). At the end of the intervention a 15% relative increase of BZD de-prescribing was also found (p < 0.01). The use of atypical antipsychotic (AAP) and other potentially harmful sedative drugs did not increase. In the surgery department, exposed to the recommendation but not to the intervention, a constant upward trend with a slope of 0.129 new prescriptions per 100 admissions per month (95% CI 0.08-0.17; p < 0.001) was seen.
The implementation of a dual intervention based on transparent monitoring-benchmarking and multidisciplinary education has proved useful in curbing new BZD prescriptions and in promoting BZD de-prescribing in the hospital setting.
减少不合理的苯二氮䓬类药物（BZD）处方是全球医疗保健系统面临的一项挑战。“明智选择”运动建议不要将 BZD 作为老年人失眠、烦躁或谵妄的首选药物。我们旨在确定在内部发布有针对性的建议的基础上，透明监测-基准测试以及教育干预是否可以有效抑制 BZD 处方。
在瑞士南部的五所教学医院网络中进行了一项多中心的前后研究。实施了一种基于透明连续监测-基准测试系统的干预措施，称为“明智报告”，能够收集、分析和报告 BZD 处方数据，并开展以主题会议、审核和反馈为重点的教育干预。该干预仅限于内科。使用分段回归分析中断时间序列，并将内科与外科进行比较，评估干预对新的 BZD 处方和出院时停药的影响。
2014 年 7 月 12 日至 2017 年 6 月 30 日，分析了内科和外科部门 45597 例住院患者的数据。在干预前（2014 年 7 月 12 日至 2015 年 12 月 31 日），每月新 BZD 处方率平均为 7.2%；在干预阶段（2016 年 1 月至 2017 年 6 月 30 日），这一数值下降至 5.5%（相对减少 24%；p<0.001）。干预结束时，还发现 BZD 停药的相对增加了 15%（p<0.01）。非典型抗精神病药物（AAP）和其他潜在有害镇静药物的使用并未增加。在外科部门，虽然接触了建议但未接触干预措施，每月每 100 例入院增加 0.129 例新处方（95%CI 0.08-0.17；p<0.001）。
基于透明监测-基准测试和多学科教育的双重干预措施的实施，在抑制新的 BZD 处方和促进医院环境中的 BZD 停药方面是有效的。
