Johnson Chris F, Nassr Ola Ali, Harpur Catherine, Kenicer David, Thom Alex, Akram Gazala
Specialist Mental Health and Prescribing Support Pharmacist Primary Care, Pharmacy and Prescribing Support Unit, NHS Greater Glasgow and Clyde, West Glasgow Ambulatory Care Hospital. Glasgow (United Kingdom).
College of Pharmacy, Al-Mustansiriya University, Baghdad (Iraq).
Pharm Pract (Granada). 2018 Jul-Sep;16(3):1256. doi: 10.18549/PharmPract.2018.03.1256. Epub 2018 Sep 26.
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.
To identify the pattern of benzodiazepine and z-hypnotic prescribing in psychiatric inpatients at discharge and 12 months post-discharge.
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.
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.
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.
在过去20年里，苯二氮䓬类药物和Z类催眠药的处方量已逐渐减少，然而长期慢性处方仍有出现，这与处方指南相悖。
确定精神科住院患者出院时及出院后12个月苯二氮䓬类药物和Z类催眠药的处方模式。
对2012年6月至11月（含）期间入住两个成人精神科病房、出院时开具苯二氮䓬类或Z类催眠药处方的患者进行回顾性观察纵向队列研究。利用从苏格兰国民保健服务处方信息系统获取的常规收集的处方数据，确定并跟踪出院后12个月内苯二氮䓬类和Z类催眠药的社区处方情况。数据录入Excel，并使用SPSS 23进行进一步分析。本服务评估无需伦理批准，但已寻求并获得考迪科特监护人的批准。
研究期间有80名患者入院，但仅纳入单次入院的患者进行分析（n = 74）。30%（22/74）的患者出院时开具了苯二氮䓬类或Z类催眠药；其中14人接受了“长期”苯二氮䓬类和Z类催眠药治疗，即在12个月期间持续用药。7名患者同时接受了抗焦虑药和催眠药联合治疗（如地西泮加替马西泮或佐匹克隆）。以地西泮等效剂量表示，长期使用与苯二氮䓬类或Z类催眠药的中位剂量无显著增加相关。
三分之一的患者出院时开具了苯二氮䓬类或Z类催眠药，五分之一的患者在出院后接受了为期12个月的持续长期治疗（处方）。由于慢性长期苯二氮䓬类 - Z类药物的处方和使用仍然是一个问题，未来利用常规患者层面处方数据的策略可能有助于开处方者审查并尽量减少不适当的长期处方行为。
