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

Johnson, Chris F. and Nassr, Ola Ali and Harpur, Catherine and Kenicer, David and Thom, Alex and Akram, Gazala (2018) Benzodiazepine and z-hypnotic prescribing from acute psychiatric inpatient discharge to long-term care in the community. Pharmacy Practice, 16 (3). ISSN 1886-3655

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    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.