Division of General Internal Medicine (Koch) and Division of Clinical Trials and Biostatistics (Butterfield), Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, USA.
BMC Prim Care. 2022 Dec 13;23(1):322. doi: 10.1186/s12875-022-01936-z.
Prescribing benzodiazepines to patients taking chronic opioid analgesic therapy increases risks of adverse events. In 2016, the Centers for Disease Control and Prevention recommended avoidance of benzodiazepine prescribing concurrently with opioids, and various organizations have instituted similar guidelines. We aimed to determine the frequency and patterns of benzodiazepine prescribing at Mayo Clinic primary care (Community Internal Medicine, Family Medicine) clinics for patients taking chronic opioid analgesic therapy and the characteristics of patients receiving the prescriptions and providers administering them.
This retrospective observational study included adult patients taking chronic opioid analgesic therapy for 2 full years in 2018 and 2019 at Mayo Clinic primary care practices in Arizona and Florida. We assessed electronic health records for these individual patients to determine whether they received a benzodiazepine prescription during the study period and how frequently they received a prescription. Variations in prescriptions by provider specialty, location, and sex were studied. Documented data included receipt of a benzodiazepine prescription by patients with at-risk alcohol use or alcohol use disorder, depression, anxiety, chronic obstructive pulmonary disease, falls, and psychiatric referral. Data were compared between patients who received benzodiazepines and those who did not with the Kruskal-Wallis test or χ test, and the Wilcoxon signed rank test was used to assess whether the change in number of benzodiazepine prescriptions (2018 vs. 2019) was different from zero.
Study participants (N = 457) were predominantly women (n = 266, 58.2%); median age was 69 years. In total, 148 patients (32.4%) received benzodiazepine prescription. These patients were more likely to be women (P = .046) and younger (P = .02). Mean percentage change was 176.9% (P < .001) in number of benzodiazepine prescriptions provided from 2018 to 2019. Frequency of referral to mental health providers was low, as was presence of an established mental health provider despite a greater prevalence of anxiety (P < .001) and depression (P = .001) among patients receiving benzodiazepines.
Benzodiazepine prescription to individual patients taking chronic opioid analgesic therapy significantly increased from 2018 to 2019 despite the documented risks and harms associated with such practice. No statistically significant difference was observed in frequency of benzodiazepine prescriptions between practice location, sex of provider, or specialty.
给服用慢性阿片类镇痛药治疗的患者开具苯二氮䓬类药物会增加不良事件的风险。2016 年，疾病控制与预防中心建议避免同时开具苯二氮䓬类药物和阿片类药物，并且许多组织都制定了类似的指南。我们旨在确定在梅奥诊所初级保健（社区内科、家庭医学）诊所接受慢性阿片类镇痛药治疗的患者开具苯二氮䓬类药物的频率和模式，以及接受处方的患者和开具处方的医生的特征。
这项回顾性观察性研究纳入了 2018 年和 2019 年在亚利桑那州和佛罗里达州梅奥诊所初级保健机构接受慢性阿片类镇痛药治疗达 2 年的成年患者。我们评估了这些个体患者的电子健康记录，以确定他们在研究期间是否收到了苯二氮䓬类药物的处方，以及他们收到处方的频率。研究了提供者专业、地点和性别的处方差异。记录的数据包括有风险的酒精使用或酒精使用障碍、抑郁、焦虑、慢性阻塞性肺疾病、跌倒和精神科转介的患者接受苯二氮䓬类药物处方的情况。使用 Kruskal-Wallis 检验或 χ2 检验比较接受苯二氮䓬类药物和未接受苯二氮䓬类药物的患者的数据，使用 Wilcoxon 符号秩检验评估 2018 年与 2019 年之间开具的苯二氮䓬类药物处方数量的变化是否与零有差异。
研究参与者（N=457）主要为女性（n=266，58.2%）；中位年龄为 69 岁。共有 148 名患者（32.4%）接受了苯二氮䓬类药物处方。这些患者更可能是女性（P=.046）和更年轻（P=.02）。从 2018 年到 2019 年，提供的苯二氮䓬类药物处方数量的平均百分比变化为 176.9%（P<0.001）。尽管焦虑（P<0.001）和抑郁（P=0.001）在接受苯二氮䓬类药物的患者中更为普遍，但精神健康提供者的转诊频率较低，而且尽管如此，建立精神健康提供者的情况也较低。
尽管有研究证明这种做法存在风险和危害，但 2018 年至 2019 年期间，给服用慢性阿片类镇痛药治疗的个体患者开具苯二氮䓬类药物的处方显著增加。在苯二氮䓬类药物处方的频率方面，未观察到实践地点、提供者性别或专业之间的统计学差异。
