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 : JGIM 2016-09, Vol.31 (9), p.1027-1034
• Main Authors: Kroll, David S., Nieva, Harry Reyes, Barsky, Arthur J., Linder, Jeffrey A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Alcohol; Alcohol abuse; Alcoholic beverages; Alcoholism - drug therapy; Alcoholism - epidemiology; Apnea; Asthma; Benzodiazepines; Benzodiazepines - adverse effects; Biocompatibility; Biomedical materials; Chronic obstructive pulmonary disease; Cohort Studies; Design factors; Dosage; Drug abuse; Drug Prescriptions - standards; Emergency medical services; Female; Health care; Humans; Internal Medicine; Longitudinal Studies; Lung diseases; Lung Diseases - drug therapy; Lung Diseases - epidemiology; Male; Medical research; Medicine; Medicine & Public Health; Mental depression; Middle Aged; Obstructive lung disease; Original Research; Osteoporosis; Patient Acceptance of Health Care; Patients; Primary care; Primary Health Care - standards; Primary Health Care - trends; Risk analysis; Risk Factors; Sleep; Sleep disorders; Smoking - adverse effects; Smoking - epidemiology; Substance use; Substance-Related Disorders - drug therapy; Substance-Related Disorders - epidemiology; Tobacco
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-016-3740-0

ABSTRACT 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