Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, 200 Springs Rd, Bedford, MA 01730. Email:
Am J Manag Care. 2019 Mar 1;25(3):e58-e65.
Use of nonbenzodiazepine sedative hypnotics, especially zolpidem, has grown substantially, raising concerns about safety. Here, we evaluated prescribing patterns of zolpidem in the Veterans Health Administration.
A cross-sectional study of veterans receiving zolpidem in the outpatient setting from October 1, 2011, to September 30, 2016.
The study population consisted of 500,332 zolpidem users (58,598 women and 441,734 men) and a random 10% sample (n = 631,449) of nonusers. We examined 2 outcomes related to inappropriate prescribing: high-dose zolpidem prescribing and overlap with benzodiazepines. We generated interrupted time series and logistic regression models to analyze these outcomes in men and women separately.
In 2016, 29.7% of female veterans received an inappropriately high guideline-discordant dosage compared with 0.1% of male veterans (P <.001 for all reported comparisons). Furthermore, more women than men had overlapping benzodiazepine and zolpidem prescriptions (18.8% vs 14.3%). In fully adjusted models, inappropriately high doses were more commonly received by younger women (adjusted odds ratios [AORs]: 2.75 for 21-39 years and 2.97 for 40-49 years compared with ≥80 years) and women with substance use disorder (AOR, 1.48). In the second inappropriateness outcome models, women with anxiety (AOR, 2.28) or schizophrenia (AOR, 2.05) and men with cancer (AOR, 1.42), anxiety (AOR, 2.66), or schizophrenia (AOR, 2.46) were more likely to receive an overlapping prescription of zolpidem and benzodiazepines.
We found evidence of inappropriate zolpidem prescribing among veterans, particularly women. Greater understanding of the drivers of this inappropriate prescribing is necessary to develop interventions to promote safer, more guideline-concordant prescribing.
非苯二氮䓬类镇静催眠药（尤其是唑吡坦）的使用大幅增加，引起了人们对安全性的担忧。在这里，我们评估了退伍军人事务部（Veterans Health Administration）中唑吡坦的处方模式。
这是一项从 2011 年 10 月 1 日至 2016 年 9 月 30 日期间在门诊接受唑吡坦治疗的退伍军人的横断面研究。
研究人群包括 500332 名唑吡坦使用者（58598 名女性和 441734 名男性）和随机抽取的 10%的非使用者样本（n=631449）。我们检查了与不适当处方相关的 2 个结果：高剂量唑吡坦处方和与苯二氮䓬类药物重叠。我们分别对男性和女性使用中断时间序列和逻辑回归模型来分析这些结果。
2016 年，29.7%的女性退伍军人接受了不适当的高剂量指南不符的治疗，而男性退伍军人中这一比例仅为 0.1%（所有报告的比较均<0.001）。此外，与男性相比，更多的女性同时接受了苯二氮䓬类药物和唑吡坦的处方（18.8%比 14.3%）。在完全调整的模型中，年轻女性（调整后的优势比[ORs]：21-39 岁为 2.75，40-49 岁为 2.97，与≥80 岁相比）和有物质使用障碍的女性（OR，1.48）更常接受高剂量唑吡坦治疗。在第二个不适当的结果模型中，患有焦虑症（OR，2.28）或精神分裂症（OR，2.05）的女性以及患有癌症（OR，1.42）、焦虑症（OR，2.66）或精神分裂症（OR，2.46）的男性更有可能接受唑吡坦和苯二氮䓬类药物的重叠处方。
我们发现退伍军人中存在唑吡坦不适当处方的证据，尤其是女性。为了制定促进更安全、更符合指南的处方的干预措施，需要进一步了解导致这种不适当处方的原因。
