Usher Institute, University of Edinburgh, Edinburgh, UK.
Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Pharmacoepidemiol Drug Saf. 2024 Dec;33(12):e70056. doi: 10.1002/pds.70056.
Survivors of critical illness are often affected by new or worsened mental health conditions and sleep disorders. We examined the incidence, practice variation and factors associated with new benzodiazepine and z-drug community prescriptions among critical illness survivors.
A retrospective cohort study using the UK Clinical Practice Research Datalink data included 52 846 adult critical care survivors hospitalised in 2010 and 2018 who were not prescribed benzodiazepines or z-drugs before hospitalisation. We performed multilevel multivariable logistic regression to assess patient factors associated with new (any prescription within 90 days) and with new-and-persistent (2+ prescriptions within 180 days) benzodiazepine or z-drug prescribing, and to evaluate variation by primary care practice.
5.2% (2769/52846) of treatment-naïve survivors (95% CI 5.1-5.4) were prescribed a benzodiazepine or z-drug, and 2.5% (1311/52846) had new-and-persistent prescribing. A history of insomnia (adjusted OR 1.96; 95% CI 1.74-2.21), anxiety or depression (adjusted OR 1.40; 95% CI 1.28-1.53) and recent prescription opioid use (adjusted OR 1.47; 95% CI 1.34-1.61) were associated with new community prescription. Sex was not associated with new prescriptions and older patients were less likely to receive a prescription. 2.6% of the variation in new prescribing and 4.1% of the variation in new-and-persistent prescribing were attributable to the prescribing practice.
One in twenty critical illness survivors receive a new community benzodiazepine or z-drug prescription. Further research is needed to understand where in the patient care pathway initiation occurs and the risk of adverse events in survivors of recent critical illness.
危重病幸存者常受到新的或恶化的心理健康状况和睡眠障碍的影响。我们研究了危重病幸存者中新的苯二氮䓬类和 Z 类药物社区处方的发生率、实践差异和相关因素。
一项回顾性队列研究使用英国临床实践研究数据链接数据，纳入了 2010 年和 2018 年住院的 52846 名成年重症监护幸存者，这些患者在住院前未开处苯二氮䓬类或 Z 类药物。我们进行了多水平多变量逻辑回归分析，以评估与新处方（90 天内任何处方）和新持续处方（180 天内 2 次或以上处方）相关的患者因素，并评估初级保健实践的差异。
5.2%（2769/52846）的治疗初治幸存者（95%CI5.1-5.4）开了苯二氮䓬类或 Z 类药物，2.5%（1311/52846）有新持续处方。失眠史（调整后的比值比 1.96；95%CI1.74-2.21）、焦虑或抑郁史（调整后的比值比 1.40；95%CI1.28-1.53）和近期处方类阿片类药物使用（调整后的比值比 1.47；95%CI1.34-1.61）与新的社区处方相关。性别与新处方无关，年龄较大的患者不太可能开处方。新处方的 2.6%和新持续处方的 4.1%的差异归因于处方实践。
五分之一的危重病幸存者接受了新的社区苯二氮䓬类或 Z 类药物处方。需要进一步研究以了解在患者治疗路径中的何处开始以及最近危重病幸存者的不良事件风险。
