Medicines Policy Research Unit, Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia.
Translational Australian Clinical Toxicology Program, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Drug Alcohol Rev. 2020 Jul;39(5):575-582. doi: 10.1111/dar.13086. Epub 2020 May 11.
Inappropriate benzodiazepine use continues to cause substantial morbidity and mortality globally. We aimed to characterise the initiation of new benzodiazepine treatment episodes in Australia and identify correlates of potentially inappropriate benzodiazepine use.
We conducted a population-based cohort study using dispensing claims from a 10% sample of Pharmaceutical Benefit Scheme eligible Australians (2014-2017). Our cohort comprised adults initiating a new benzodiazepine treatment; we defined potentially inappropriate use as ≥3 benzodiazepine dispensing over any continuous 90-day period in the year following initiation. We examined characteristics associated with potentially inappropriate benzodiazepine use using multivariable logistic regression.
People initiating a new benzodiazepine treatment episode (n = 276 765) were more frequently female (59.1%) and <65 years of age (73.6%). In the 90 days prior to initiating benzodiazepine, people were commonly dispensed antidepressants (26.5%), opioid analgesics (17.6%) and antipsychotics (4.7%). In the first year after initiation, 20 938 (9.5%) people experienced 'potentially inappropriate use'. Having a greater initial quantity of benzodiazepine dispensed [odds ratio (OR), 1.10; 95% confidence interval (CI) 1.08-1.12 per 10 defined daily doses increase], dispensing of antipsychotics (OR 3.00, 95% CI 2.86-3.15) and >5 unique medicines (OR 2.54, 95% CI 2.44-2.64; vs. ≤5 unique medicines) in the 90 days prior to initiation were associated with potentially inappropriate benzodiazepine use.
Approximately, 1 in 10 people who initiated benzodiazepines were using it beyond the guideline recommended period. We identified factors at the time of initiation associated with potentially inappropriate use; clinicians should consider these before prescribing benzodiazepines and initiate conversations about alternative therapy when necessary.
在全球范围内，不适当的苯二氮䓬类药物的使用仍会导致大量的发病率和死亡率。我们旨在描述澳大利亚新苯二氮䓬类药物治疗发作的特征，并确定潜在不适当苯二氮䓬类药物使用的相关因素。
我们使用 10%的合格澳大利亚人（2014-2017 年）的配药索赔进行了一项基于人群的队列研究。我们的队列包括开始新的苯二氮䓬类药物治疗的成年人；我们将潜在不适当的使用定义为在开始后的 90 天内，任何连续 90 天内的≥3 次苯二氮䓬类药物配药。我们使用多变量逻辑回归检查与潜在不适当的苯二氮䓬类药物使用相关的特征。
开始新的苯二氮䓬类药物治疗发作的人（n=276765）中，女性（59.1%）和<65 岁的人（73.6%）更为常见。在开始使用苯二氮䓬之前的 90 天内，人们通常被开了抗抑郁药（26.5%）、阿片类镇痛药（17.6%）和抗精神病药（4.7%）。在开始后的第一年，有 20938 人（9.5%）经历了“潜在的不适当使用”。初始苯二氮䓬类药物的剂量更大[比值比（OR），1.10；95%置信区间（CI）每增加 10 个定义的每日剂量增加 1.08-1.12]，在开始前的 90 天内开抗精神病药（OR 3.00，95%CI 2.86-3.15）和>5 种不同药物（OR 2.54，95%CI 2.44-2.64；与≤5 种不同药物相比）与潜在的不适当使用有关。
大约每 10 个开始使用苯二氮䓬类药物的人中就有 1 个使用时间超过了指南推荐的时间。我们确定了与潜在不适当使用相关的起始时的因素；临床医生在开苯二氮䓬类药物之前应考虑这些因素，并在必要时开始讨论替代治疗方案。
