Benzodiazepine and z-hypnotic prescribing from acute psychiatric inpatient discharge to long-term care in the community

Chris F. Johnson, Ola Ali Nassr, Catherine Harpur, David Kenicer, Alex Thom, Gazala Akram

Research output: Contribution to journalArticle

Abstract

Background: Benzodiazepine andz-hypnotic prescribing has slowly decreased over the past 20 years, howeverlong-term chronic prescribing still occurs and is at odds with prescribingguidance. Objective: To identify the patternof benzodiazepine and z-hypnotic prescribing in psychiatric inpatients atdischarge and 12 months post-discharge. Methods: Retrospectiveobservational longitudinal cohort study of patients admitted to two adultpsychiatric wards between June and November 2012 (inclusive) who weredischarged with a prescription for a benzodiazepine and/or z-hypnotic drug.Routinely collected prescription data available from NHS Scotland PrescribingInformation System was used to identify and follow community prescribing of benzodiazepineand z-hypnotics for a 12 month period post-discharge. Data were entered inExcel® and further analysed using SPSS 23. Ethical approval was notrequired for this service evaluation however Caldicott Guardian approval wassought and granted. Results: Eighty patients wereadmitted during the study period however only those patients with a singleadmission were included for analysis (n=74). Thirty per cent (22/74) of patients wereprescribed a benzodiazepine and/or z-hypnotics at discharge; 14 of whomreceived ‘long-term’ benzodiazepine and z-hypnotics i.e. continued use over the12 month period. Seven patients receiveda combination of anxiolytics and hypnotics e.g. diazepam plus temazepam orzopiclone. Long-term use was associatedwith a non-significant increase in median benzodiazepine and/or z-hypnoticdose, expressed as diazepam equivalents. Conclusions: One in threepatients were prescribed a benzodiazepine and/or z-hypnotics at discharge with1 in 5 receiving continuous long-term treatment (prescriptions) for 12 monthspost-discharge. As chronic long-term B-Zprescribing and use still remains an issue, future strategies using routine patient-levelprescribing data may support prescribers to review and minimise inappropriatelong-term prescribing.
LanguageEnglish
Article number1256
Number of pages7
JournalPharmacy Practice
Volume16
Issue number3
DOIs
Publication statusPublished - 26 Sep 2018

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Long-Term Care
Hypnotics and Sedatives
Benzodiazepines
Psychiatry
Inpatients
Prescriptions
Diazepam
Temazepam
Anti-Anxiety Agents
Scotland
Longitudinal Studies
Cohort Studies
Pharmaceutical Preparations

Keywords

  • benzodiazepines
  • patient discharge
  • practice patterns
  • psychiatric department

Cite this

Johnson, Chris F. ; Nassr, Ola Ali ; Harpur, Catherine ; Kenicer, David ; Thom, Alex ; Akram, Gazala. / Benzodiazepine and z-hypnotic prescribing from acute psychiatric inpatient discharge to long-term care in the community. In: Pharmacy Practice. 2018 ; Vol. 16, No. 3.
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Benzodiazepine and z-hypnotic prescribing from acute psychiatric inpatient discharge to long-term care in the community. / Johnson, Chris F.; Nassr, Ola Ali; Harpur, Catherine; Kenicer, David; Thom, Alex; Akram, Gazala.

In: Pharmacy Practice, Vol. 16, No. 3, 1256, 26.09.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Benzodiazepine and z-hypnotic prescribing from acute psychiatric inpatient discharge to long-term care in the community

AU - Johnson, Chris F.

AU - Nassr, Ola Ali

AU - Harpur, Catherine

AU - Kenicer, David

AU - Thom, Alex

AU - Akram, Gazala

PY - 2018/9/26

Y1 - 2018/9/26

N2 - Background: Benzodiazepine andz-hypnotic prescribing has slowly decreased over the past 20 years, howeverlong-term chronic prescribing still occurs and is at odds with prescribingguidance. Objective: To identify the patternof benzodiazepine and z-hypnotic prescribing in psychiatric inpatients atdischarge and 12 months post-discharge. Methods: Retrospectiveobservational longitudinal cohort study of patients admitted to two adultpsychiatric wards between June and November 2012 (inclusive) who weredischarged with a prescription for a benzodiazepine and/or z-hypnotic drug.Routinely collected prescription data available from NHS Scotland PrescribingInformation System was used to identify and follow community prescribing of benzodiazepineand z-hypnotics for a 12 month period post-discharge. Data were entered inExcel® and further analysed using SPSS 23. Ethical approval was notrequired for this service evaluation however Caldicott Guardian approval wassought and granted. Results: Eighty patients wereadmitted during the study period however only those patients with a singleadmission were included for analysis (n=74). Thirty per cent (22/74) of patients wereprescribed a benzodiazepine and/or z-hypnotics at discharge; 14 of whomreceived ‘long-term’ benzodiazepine and z-hypnotics i.e. continued use over the12 month period. Seven patients receiveda combination of anxiolytics and hypnotics e.g. diazepam plus temazepam orzopiclone. Long-term use was associatedwith a non-significant increase in median benzodiazepine and/or z-hypnoticdose, expressed as diazepam equivalents. Conclusions: One in threepatients were prescribed a benzodiazepine and/or z-hypnotics at discharge with1 in 5 receiving continuous long-term treatment (prescriptions) for 12 monthspost-discharge. As chronic long-term B-Zprescribing and use still remains an issue, future strategies using routine patient-levelprescribing data may support prescribers to review and minimise inappropriatelong-term prescribing.

AB - Background: Benzodiazepine andz-hypnotic prescribing has slowly decreased over the past 20 years, howeverlong-term chronic prescribing still occurs and is at odds with prescribingguidance. Objective: To identify the patternof benzodiazepine and z-hypnotic prescribing in psychiatric inpatients atdischarge and 12 months post-discharge. Methods: Retrospectiveobservational longitudinal cohort study of patients admitted to two adultpsychiatric wards between June and November 2012 (inclusive) who weredischarged with a prescription for a benzodiazepine and/or z-hypnotic drug.Routinely collected prescription data available from NHS Scotland PrescribingInformation System was used to identify and follow community prescribing of benzodiazepineand z-hypnotics for a 12 month period post-discharge. Data were entered inExcel® and further analysed using SPSS 23. Ethical approval was notrequired for this service evaluation however Caldicott Guardian approval wassought and granted. Results: Eighty patients wereadmitted during the study period however only those patients with a singleadmission were included for analysis (n=74). Thirty per cent (22/74) of patients wereprescribed a benzodiazepine and/or z-hypnotics at discharge; 14 of whomreceived ‘long-term’ benzodiazepine and z-hypnotics i.e. continued use over the12 month period. Seven patients receiveda combination of anxiolytics and hypnotics e.g. diazepam plus temazepam orzopiclone. Long-term use was associatedwith a non-significant increase in median benzodiazepine and/or z-hypnoticdose, expressed as diazepam equivalents. Conclusions: One in threepatients were prescribed a benzodiazepine and/or z-hypnotics at discharge with1 in 5 receiving continuous long-term treatment (prescriptions) for 12 monthspost-discharge. As chronic long-term B-Zprescribing and use still remains an issue, future strategies using routine patient-levelprescribing data may support prescribers to review and minimise inappropriatelong-term prescribing.

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KW - patient discharge

KW - practice patterns

KW - psychiatric department

UR - https://www.pharmacypractice.org/journal/index.php/pp/article/view/1256

U2 - 10.18549/PharmPract.2018.03.1256

DO - 10.18549/PharmPract.2018.03.1256

M3 - Article

VL - 16

JO - Pharmacy Practice

T2 - Pharmacy Practice

JF - Pharmacy Practice

SN - 1885-642X

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