Published in:
01-09-2016 | Original Research
Benzodiazepines are Prescribed More Frequently to Patients Already at Risk for Benzodiazepine-Related Adverse Events in Primary Care
Published in: Journal of General Internal Medicine | Issue 9/2016
Login to get accessABSTRACT
Background
Benzodiazepine use is associated with adverse drug events and higher mortality. Known risk factors for benzodiazepine-related adverse events include lung disease, substance use, and vulnerability to fracture.
Objective
To determine whether benzodiazepine prescribing is associated with risk factors for adverse outcomes.
Design
Longitudinal cohort study between July 1, 2011, and June 30, 2012.
Participants
Patients who visited hospital- and community-based practices in a primary care practice-based research network.
Main Measures
Odds ratio of having a target medical diagnosis for patients who received standard and high-dose benzodiazepine prescriptions; rates per 100 patients for outpatient and emergency department visits and hospitalizations.
Key Results
Among 65,912 patients, clinicians prescribed at least one benzodiazepine to 15 % (9821). Of benzodiazepine recipients, 5 % received high doses. Compared to non-recipients, benzodiazepine recipients were more likely to have diagnoses of depression (OR, 2.7; 95 % CI, 2.6–2.9), substance abuse (OR, 2.2; 95 % CI, 1.9–2.5), tobacco use (OR, 1.7; 95 % CI, 1.5–1.8), osteoporosis (OR, 1.6; 95 % CI, 1.5–1.7), chronic obstructive pulmonary disease (OR, 1.6; 95 % CI, 1.5–1.7), alcohol abuse (OR, 1.5; 95 % CI, 1.3–1.7), sleep apnea (OR, 1.5; 95 % CI, 1.3–1.6), and asthma (OR, 1.5; 95 % CI, 1.4–1.5). Compared to low-dose benzodiazepine recipients, high-dose benzodiazepine recipients were even more likely to have certain medical diagnoses: substance abuse (OR, 7.5; 95 % CI, 5.5–10.1), alcohol abuse (OR, 3.2; 95 % CI, 2.2–4.5), tobacco use (OR, 2.7; 95 % CI, 2.1–3.5), and chronic obstructive pulmonary disease (OR, 1.5; 95 % CI, 1.2–1.9). Benzodiazepine recipients had more primary care visits per 100 patients (408 vs. 323), specialist outpatient visits (815 vs. 578), emergency department visits (47 vs. 29), and hospitalizations (26 vs. 15; p < .001 for all comparisons).
Conclusions
Clinicians prescribed benzodiazepines and high-dose benzodiazepines more frequently to patients at higher risk for benzodiazepine-related adverse events. Benzodiazepine prescribing was associated with increased healthcare utilization.