College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Faculty of Science, University of Manitoba, Winnipeg, Manitoba, Canada.
BMC Prim Care. 2022 May 10;23(1):111. doi: 10.1186/s12875-022-01724-9.
Despite the known safety risks of long-term use of sedative-hypnotic/anxiolytic medications, there has been limited guidance for the safe and effective use of their chronic use in a primary care clinic setting. Understanding the characteristics of patients who receive sedative-hypnotic/anxiolytic medication and the clinical documentation process in primary care is the first step towards understanding the nature of the problem and will help inform future strategies for clinical research and practice.
Characterize patients who received a sedative-hypnotic/anxiolytic prescription in primary care, and (2) gain an understanding of the clinical documentation of sedative-hypnotic/anxiolytic indication and monitoring in electronic medical records (EMR).
A random selection of patients who received a prescription for a benzodiazepine or Z-drug hypnotic between January 2014 and August 2016 from four primary care clinics in Winnipeg were included. Data was collected retrospectively using the EMR (Accuro®). Patient variables recorded included sex, age, comorbidities, medications, smoking status, and alcohol status. Treatment variables included drug type, indication, pattern of use, dose, adverse events, psychosocial intervention, tapering attempts, social support, life stressor, and monitoring parameters for sedative-hypnotic use. Demographic and clinical characteristics were described using descriptive statistics.
Records from a sample of 200 primary care patients prescribed sedative-hypnotic/anxiolytics were analyzed (mean age 55.8 years old, 61.5% ≥ 65 years old, 61.0% female). Long-term chronic use (≥ 1 year) of a sedative-hypnotic/anxiolytic agent was observed in 29.5% of the sample. Zopiclone (30.7%) and lorazepam (28.7%) were the most common agents prescribed. Only 9.5% of patients had documentation of a past tapering attempt of their sedative-hypnotic/anxiolytic. The most common indications for sedative-hypnotic/anxiolytic use recorded were anxiety (33.0%) and sleep (18.0%), but indication was undetermined for 57.0% of patients. Depression (33.5%) and falls (18.5%) were reported by patients after the initiation of these agents.
A higher proportion of females and users 65 years and older received a prescription for a sedative-hypnotic/anxiolytic, consistent with previous studies on sedative-hypnotic use. We found inconsistencies in the documentation surrounding sedative-hypnotic/anxiolytic use. The indication for their use was unclear in a large number of patients. These findings will help us understand the state of the problem in primary care and inform future strategies for clinical research.
尽管长期使用镇静催眠/抗焦虑药物存在已知的安全风险，但在初级保健诊所环境中，关于此类药物的安全有效使用，仅有有限的指导。了解接受镇静催眠/抗焦虑药物治疗的患者的特征以及初级保健中的临床记录过程，是了解问题性质的第一步，这将有助于为未来的临床研究和实践策略提供信息。
描述在初级保健中接受镇静催眠/抗焦虑药物处方的患者特征，并（2）了解电子病历（EMR）中镇静催眠/抗焦虑药物指征和监测的临床记录情况。
从温尼伯的四家初级保健诊所中，随机选择了 2014 年 1 月至 2016 年 8 月期间接受苯二氮䓬类或 Z 类催眠药物处方的患者。使用 EMR（Accuro®）进行回顾性数据收集。记录的患者变量包括性别、年龄、合并症、药物、吸烟状况和饮酒状况。治疗变量包括药物类型、指征、使用模式、剂量、不良反应、心理社会干预、减量尝试、社会支持、生活压力源以及镇静催眠药物使用的监测参数。使用描述性统计方法描述人口统计学和临床特征。
对 200 名接受镇静催眠/抗焦虑药物处方的初级保健患者的记录进行了分析（平均年龄 55.8 岁，61.5%≥65 岁，61.0%为女性）。观察到样本中 29.5%的患者存在长期慢性使用（≥1 年）镇静催眠/抗焦虑药物的情况。处方最常见的药物为佐匹克隆（30.7%）和劳拉西泮（28.7%）。仅有 9.5%的患者有记录表明曾尝试过镇静催眠/抗焦虑药物的减量。记录的镇静催眠/抗焦虑药物使用的最常见指征为焦虑（33.0%）和睡眠（18.0%），但 57.0%的患者的指征不确定。患者在开始使用这些药物后报告了抑郁（33.5%）和跌倒（18.5%）。
与之前关于镇静催眠药物使用的研究一致，更多的女性和 65 岁及以上的患者接受了镇静催眠/抗焦虑药物的处方。我们发现，镇静催眠/抗焦虑药物使用的记录存在不一致的情况。在大量患者中，其使用指征不明确。这些发现将帮助我们了解初级保健中的问题状况，并为未来的临床研究策略提供信息。
