Discontinuation of Chronic Benzodiazepine Use Among Adults in the United States
Discontinuation of Chronic Benzodiazepine Use Among Adults in the United States
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DOI：
10.1007/s11606-019-05098-0
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发表时间：
2019-09-01
影响因子：
5.7
通讯作者：
Maust, Donovan T.
中科院分区：
文献类型：
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作者：
Gerlach, Lauren B.;Strominger, Julie;Maust, Donovan T.
背景指南建议大多数苯二氮类药物(BZD)治疗是短期的，尽管BZD的慢性使用正在增加。目的确定BZD在长期使用者中的停药率，并找出与停药相关的患者和提供者层面的因素。设计、设置和参与者一项回溯性队列研究，使用2014年至2016年全国范围内的保险索赔数据，研究对象为18岁的美国成年人，在基线年份内长期使用BZD(即120天)。主要结果和指标主要结果是长期服用BZD的患者在随访1年后停止服用BZD。一系列多水平Logistic回归模型检验了BZD停药与患者和提供者特征之间的关系。协变量包括患者社会人口学、内科和精神科共病、共同处方的阿片类药物和其他精神药物，以及处方的BZD的特征。141,008名慢性BZD使用者的主要结果，13.4%的人在1年后停止使用。女性患者停药的几率较低(AOR为0.83，99%CI为0.79~0.87)，而非洲裔美国患者的停药几率较高(AOR为1.12，99%CI为1.03~1.22)。服用高效BZD的患者停用的几率较低(AOR 0.51，99%CI为0.47~0.54)，开阿片类药物的患者停药的几率也较低(AOR为0.94，99%CI为0.89~0.99)。在调整了患者和提供者水平的因素后，提供者之间的差异解释了BZD停用差异的5.8%(p<；0.001)。提供者的中位优势比为1.54，与停药的关联比几乎所有患者水平的临床变量都大。结论在特定年份服用慢性BZD的少数患者在1年后不再服用BZD。在非临床因素(如种族、地理和患者的提供者)导致的停药可能性方面存在显著差异，与几乎所有其他患者级别的变量相比，这些因素与停药几率的相关性更强。减少BZD处方的干预措施中面向提供者的要素可能是至关重要的。
Background Guidelines recommend most benzodiazepine (BZD) treatment be short-term, though chronic BZD use is increasing. Objective Determine the rate of BZD discontinuation among chronic users and identify patient- and provider-level factors associated with discontinuation. Design, Setting, and Participants A retrospective cohort study using nationwide insurance claims data from 2014 to 2016 of US adults >= 18 years old with chronic BZD use (i.e., > 120 days) during the baseline year. Main Outcomes and Measures The primary outcome was BZD discontinuation among chronic users after 1 year of follow-up. A series of multilevel logistic regression models examined the association of BZD discontinuation with patient and provider characteristics. Covariates included patient sociodemographics, medical and psychiatric comorbidity, co-prescribed opioids and other psychotropics, and characteristics of the prescribed BZD. Key Results Of 141,008 chronic BZD users, 13.4% discontinued use after 1 year. Females had lower odds of discontinuation (AOR 0.83, 99% CI 0.79-0.87), while African-American patients had higher odds (AOR 1.12, 99% CI 1.03-1.22). Those prescribed a high-potency BZD had lower odds of discontinuation (AOR 0.51, 99% CI 0.47-0.54), as did those prescribed an opioid (AOR 0.94, 99% CI 0.89-0.99). After adjusting for patient- and provider-level factors, differences between providers accounted for 5.8% of variation in BZD discontinuation (p < 0.001). The median odds ratio for provider was 1.54, an association with discontinuation larger than almost all patient-level clinical variables. Conclusions A small minority of patients prescribed chronic BZD in a given year are no longer prescribed BZDs 1 year later. There is significant variation in the likelihood of discontinuation accounted for by non-clinical factors such as race, geography, and a patient's provider, which had a stronger association with the odds of discontinuation than almost every other patient-level variable. Provider-facing elements of interventions to reduce BZD prescribing may be critical.