Clinical Pharmacy Research Group, Université Catholique de Louvain, Louvain Drug Research Institute, Brussels, Belgium.
Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium.
J Am Geriatr Soc. 2020 Dec;68(12):2768-2777. doi: 10.1111/jgs.16751. Epub 2020 Aug 12.
BACKGROUND/OBJECTIVES: To describe the use and deprescribing of benzodiazepine receptor agonists (BZRAs) among nursing home residents (NHRs), to evaluate appropriateness of use and to identify factors associated with BZRA use and deprescribing.
Posthoc analysis of the Collaborative Approach to Optimize Medication Use for Older People in Nursing Homes (COME-ON) study, a cluster controlled trial that evaluated the impact of a complex intervention on potentially inappropriate prescriptions (PIPs) in nursing homes (NHs).
A total of 54 NHs in Belgium.
A total of 797 NHRs included in the study who had complete medical, clinical, and medication information at baseline and at the end of the study (month 15).
Data were recorded by participating healthcare professionals. Reasons why BZRA use was considered as PIPs were assessed using the 2019 American Geriatrics Society Beers Criteria® and the Screening Tool of Older Persons' Prescriptions (STOPP) criteria, version 2. Deprescribing included complete cessation or decreased daily dose. We identified factors at the NHR, prescriber, and NH levels associated with BZRA use and BZRA deprescribing using multivariable binary and multinomial logistic regression, respectively.
At baseline, 418 (52.4%) NHRs were taking a BZRA. The use of BZRA for longer than 4 weeks, with two or more other central nervous system active drugs, and in patients with delirium, cognitive impairment, falls, or fractures was found in more than 67% of BZRA users. Eight NHR-related variables and two prescriber-related variables were associated with regular BZRA use. Deprescribing occurred in 28.1% of BZRA users (32.9% in the intervention group and 22.1% in the control group). In addition to four other factors, dementia (odds ratio [OR] = 2.35; 95% confidence interval [CI] = [1.45-3.83]) and intervention group (OR = 1.74; 95% CI = 1.07-2.87) were associated with deprescribing.
Use of BZRAs was highly prevalent, and reasons to consider it as PIP were frequent. Deprescribing occurred in one-fourth of NHRs, which is encouraging. Future interventions should focus on specific aspects of PIPs (ie, indication, duration, drug-drug and drug-disease interactions) as well as on nondementia patients.
背景/目的：描述养老院居民（NHRs）中苯二氮䓬受体激动剂（BZRAs）的使用和减用情况，评估使用的合理性，并确定与 BZRA 使用和减用相关的因素。
对优化养老院老年人药物使用的协作方法（COME-ON）研究进行事后分析，这是一项集群对照试验，评估了一项复杂干预措施对养老院（NHs）中潜在不适当处方（PIPs）的影响。
比利时的 54 家 NHs。
共纳入研究的 797 名 NHRs，他们在基线和研究结束时（第 15 个月）有完整的医疗、临床和药物信息。
由参与的医疗保健专业人员记录数据。使用 2019 年美国老年医学会 Beers 标准®和老年人处方筛选工具（STOPP）标准版本 2 评估 BZRA 使用被视为 PIP 的原因。减用包括完全停止或减少每日剂量。我们使用多变量二项和多项逻辑回归分别确定与 BZRA 使用和 BZRA 减用相关的 NHR、处方者和 NH 水平的因素。
在基线时，418 名（52.4%）NHRs正在服用 BZRA。在超过 67%的 BZRA 使用者中，BZRA 的使用时间超过 4 周，同时使用两种或两种以上其他中枢神经系统活性药物，以及患有谵妄、认知障碍、跌倒或骨折。与常规 BZRA 使用相关的有 8 个 NHR 相关变量和 2 个处方者相关变量。BZRA 使用者中有 28.1%（干预组为 32.9%，对照组为 22.1%）进行了减用。除了其他四个因素外，痴呆症（比值比[OR] = 2.35；95%置信区间[CI] = [1.45-3.83]）和干预组（OR = 1.74；95%CI = 1.07-2.87）与减用相关。
BZRAs 的使用非常普遍，将其视为 PIP 的理由也很常见。四分之一的 NHRs 进行了减用，这是令人鼓舞的。未来的干预措施应侧重于 PIP 的特定方面（即适应症、持续时间、药物-药物和药物-疾病相互作用）以及非痴呆症患者。
