Sealy Center On Aging, The University of Texas Medical Branch, Galveston, TX, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street E7640, Baltimore, MD, 21205, USA.
Eur J Clin Pharmacol. 2022 Mar;78(3):489-496. doi: 10.1007/s00228-021-03244-4. Epub 2021 Nov 2.
Because of toxicities, benzodiazepines are not usually recommended in older adults. We therefore sought to describe the trends in benzodiazepine use in long-term care and examine the variation in benzodiazepine use among nursing homes.
In this retrospective repeated cross-sectional analysis of Medicare Parts A, B, and D claims data linked to the Minimum Data Set from 2013 to 2018, we included long-term residents who stayed in a nursing home for at least one entire quarter of a calendar year in 2013-2018. The outcome was whether residents were prescribed a benzodiazepine drug for at least 30 days during each quarter stay. We use mixed effects logistic regression models to assess the variation in benzodiazepine use among nursing homes, adjusting for patient and nursing home characteristics.
The cohort for the time trend analysis included 270,566 unique residents and 1,843,580 quarter stays for 2013-2018. Prescribing rates for short-acting benzodiazepines were stable over 2013-2016, then declined from 12.1% in 2016 to 10.6% in 2018. The rate of long-acting benzodiazepine use remained relatively steady at around 4% over 2013-2018. During 2017-2018, the variation among nursing homes in benzodiazepine use was 7.2% for short-acting vs. 9.3% for long-acting benzodiazepines, after controlling for resident characteristics.
Prescribing for short-acting benzodiazepines in long-term care declined after 2016, while long-acting benzodiazepine use did not change. The variation in benzodiazepine use among nursing homes is substantial. Identifying factors that explain this variation may help in developing strategies for deprescribing benzodiazepines in nursing home residents.
由于毒性作用，苯二氮䓬类药物通常不建议在老年人中使用。因此，我们旨在描述长期护理中苯二氮䓬类药物的使用趋势，并研究养老院之间苯二氮䓬类药物使用的差异。
在这项对 2013 年至 2018 年医疗保险 A、B 和 D 部分索赔数据与最低数据集进行的回顾性重复横断面分析中，我们纳入了在 2013 年至 2018 年期间至少在一个完整季度内居住在养老院的长期居民。结果是居民在每个季度的居住期间是否至少开了 30 天的苯二氮䓬类药物。我们使用混合效应逻辑回归模型评估养老院之间苯二氮䓬类药物使用的差异，同时调整患者和养老院的特征。
时间趋势分析的队列包括 270566 名独特居民和 2013-2018 年的 1843580 个季度入住。短效苯二氮䓬类药物的处方率在 2013-2016 年期间保持稳定，然后从 2016 年的 12.1%下降到 2018 年的 10.6%。长效苯二氮䓬类药物的使用率在 2013-2018 年期间相对稳定在 4%左右。在 2017-2018 年期间，控制了居民特征后，养老院之间短效苯二氮䓬类药物的使用差异为 7.2%，而长效苯二氮䓬类药物的使用差异为 9.3%。
长期护理中短效苯二氮䓬类药物的处方量在 2016 年后下降，而长效苯二氮䓬类药物的使用没有变化。养老院之间苯二氮䓬类药物的使用差异很大。确定解释这种差异的因素可能有助于制定减少养老院居民苯二氮䓬类药物处方的策略。
