National Center for PTSD, Veterans Affairs Medical Center, White River Junction, Vermont, and Department of Psychiatry, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
Corresponding author: Nancy C. Bernardy, PhD, National Center for PTSD (116D), White River Junction VA Medical Center, 215 North Main, White River Junction, VT 05001 (
J Clin Psychiatry. 2022 Mar 14;83(3):21m14128. doi: 10.4088/JCP.21m14128.
Our objective was to characterize benzodiazepine prescribing changes among veterans with posttraumatic stress disorder (PTSD) and inform efforts to deimplement low-value prescribing practices. This retrospective observational study used national Veterans Health Administration (VHA) administrative databases to examine annual period prevalence and incidence of benzodiazepine prescribing from 2009 through 2019 in veterans with PTSD. () codes were used to identify PTSD. Temporal trends in discontinuation rates, incidence rates, and prevalent prescribing among patients newly engaged in PTSD care were measured. Benzodiazepine prevalence in veterans with PTSD declined from 31.3% in 2009 to 10.7% in 2019, and incidence decreased from 11.4% to 2.9%, along with a 30% decrease in daily doses. Increasing discontinuation rates accounted for 21.0% of the decline in prevalence, while decreasing incidence among existing patients accounted for 36.8%, and decreased prevalence among new PTSD cohort entrants accounted for 42.2%. Women received benzodiazepines more commonly than men (odds ratio [OR] = 1.67; 95% CI, 1.64-1.70). The proportion of older adults increased over time among both existing (2009: 14.5%; 2019: 46.5%) and new (2009: 8.6%; 2019: 24.3%) benzodiazepine recipients. Benzodiazepine prescribing in VHA among veterans with PTSD showed changes driven by decreases in prevalence among new PTSD cohort entrants, with smaller changes in discontinuation and decreased incidence among existing patients. Educational initiatives may have curtailed benzodiazepine prescribing through promotion of effective alternative treatment options and supporting discontinuation through various tapering strategies. These initiatives offer resources and lessons to other health care systems to deimplement inappropriate benzodiazepine prescribing and other potentially harmful practices through patient-centered approaches that promote viable treatment alternatives.
我们的目标是描述创伤后应激障碍（PTSD）退伍军人中苯二氮䓬类药物的处方变化，并为实施低价值处方实践提供信息。这项回顾性观察性研究使用国家退伍军人健康管理局（VHA）的行政数据库，检查了 2009 年至 2019 年 PTSD 退伍军人中苯二氮䓬类药物的年度流行率和发病率。使用（）代码来识别 PTSD。测量了新参与 PTSD 治疗的患者中停药率、发病率和普遍处方的时间趋势。退伍军人 PTSD 患者中苯二氮䓬的流行率从 2009 年的 31.3%下降到 2019 年的 10.7%，发病率从 11.4%下降到 2.9%，同时日剂量减少了 30%。停药率的增加占流行率下降的 21.0%，而现有患者发病率的下降占 36.8%，新 PTSD 队列进入者的流行率下降占 42.2%。女性接受苯二氮䓬类药物的比例高于男性（比值比[OR] = 1.67；95%CI，1.64-1.70）。在现有的（2009 年：14.5%；2019 年：46.5%）和新的（2009 年：8.6%；2019 年：24.3%）苯二氮䓬类药物接受者中，老年人的比例随着时间的推移而增加。退伍军人 PTSD 患者的 VHA 苯二氮䓬类药物治疗发生了变化，这是由新 PTSD 队列进入者的流行率下降驱动的，而现有患者的停药率和发病率变化较小。教育计划可能通过推广有效的替代治疗方案，并通过各种逐渐减少策略来支持停药，从而减少了苯二氮䓬类药物的处方。这些计划为其他医疗保健系统提供了资源和经验教训，通过以患者为中心的方法来实施适当的苯二氮䓬类药物处方和其他潜在有害实践，从而推广可行的治疗替代方案。
