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      Benzodiazepine and Z-drug prescribing in Ireland: analysis of national prescribing trends from 2005 to 2015 : BZD/Z-drug prescribing trends in Ireland

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          Abstract

          <div class="section"> <a class="named-anchor" id="bcp13570-sec-0001"> <!-- named anchor --> </a> <h5 class="section-title" id="d296841e266">Aims</h5> <p id="d296841e268">The aim of this study was to examine prescribing trends for benzodiazepines and Z‐drugs to General Medical Services (GMS) patients in Ireland. </p> </div><div class="section"> <a class="named-anchor" id="bcp13570-sec-0002"> <!-- named anchor --> </a> <h5 class="section-title" id="d296841e271">Methods</h5> <p id="d296841e273">A repeated cross‐sectional analysis of the national pharmacy claims database was conducted for GMS patients aged ≥16 years from 2005 to 2015. Prescribing rates per 1000 eligible GMS population were calculated with 95% confidence intervals (CIs). Negative binomial regression was used to determine longitudinal trends and compare prescribing rates across years, gender and age groups. Duration of supply and rates of concomitant benzodiazepine and Z‐drug prescribing were determined. Age (16–44, 45–64, ≥65 years) and gender trends were investigated. </p> </div><div class="section"> <a class="named-anchor" id="bcp13570-sec-0003"> <!-- named anchor --> </a> <h5 class="section-title" id="d296841e276">Results</h5> <p id="d296841e278">Benzodiazepine prescribing rates decreased significantly from 225.92/1000 population (95% CI 224.94–226.89) in 2005 to 166.07/1000 population (95% CI 165.38–166.75) in 2015 ( <span style="italic-in-any-context">P</span> &lt; 0.0001). Z‐drug prescribing rates increased significantly from 95.36/1000 population (95% CI 94.73–96.00) in 2005 to 109.11/1000 population (95% CI 108.56–109.67) in 2015 ( <span style="italic-in-any-context">P</span> = 0.048). Approximately one‐third of individuals dispensed either benzodiazepines or Z‐drugs were receiving long‐term prescriptions (&gt;90 days). The proportion of those receiving &gt;1 benzodiazepine and/or Z‐drug concomitantly increased from 11.9% in 2005 to 15.3% in 2015. Benzodiazepine and Z‐drug prescribing rates were highest for older women (≥65 years) throughout the study period. </p> </div><div class="section"> <a class="named-anchor" id="bcp13570-sec-0004"> <!-- named anchor --> </a> <h5 class="section-title" id="d296841e287">Conclusions</h5> <p id="d296841e289">Benzodiazepine prescribing to the GMS population in Ireland decreased significantly from 2005 to 2015, and was coupled with significant increases in Z‐drug prescribing. The study shows that benzodiazepine and Z‐drug prescribing is common in this population, with high proportions of individuals receiving long‐term prescriptions. Targeted interventions are needed to reduce potentially inappropriate long‐term prescribing and use of these medications in Ireland. </p> </div>

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          Most cited references38

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          Meta-analysis of the impact of 9 medication classes on falls in elderly persons.

          There is increasing recognition that the use of certain medications contributes to falls in seniors. Our objective was to update a previously completed meta-analysis looking at the association of medication use and falling to include relevant drug classes and new studies that have been completed since a previous meta-analysis. Studies were identified through a systematic search of English-language articles published from 1996 to 2007. We identified studies that were completed on patients older than 60 years, looking at the association between medication use and falling. Bayesian methods allowed us to combine the results of a previous meta-analysis with new information to estimate updated Bayesian odds ratios (ORs) and 95% credible intervals (95% CrIs) Of 11 118 identified articles, 22 met our inclusion criteria. Meta-analyses were completed on 9 unique drug classes, including 79 081 participants, with the following Bayesian unadjusted OR estimates: antihypertensive agents, OR, 1.24 (95% CrI, 1.01-1.50); diuretics, OR, 1.07 (95% CrI, 1.01-1.14); beta-blockers, OR, 1.01 (95% CrI, 0.86-1.17); sedatives and hypnotics, OR, 1.47 (95% CrI, 1.35-1.62); neuroleptics and antipsychotics, OR, 1.59 (95% CrI, 1.37-1.83); antidepressants, OR, 1.68 (95% CrI, 1.47-1.91); benzodiazepines, OR, 1.57 (95% CrI, 1.43-1.72); narcotics, OR, 0.96 (95% CrI, 0.78-1.18); and nonsteroidal anti-inflammatory drugs, OR, 1.21 (95% CrI, 1.01-1.44). The updated Bayesian adjusted OR estimates for diuretics, neuroleptics and antipsychotics, antidepressants, and benzodiazepines were 0.99 (95% CrI, 0.78-1.25), 1.39 (95% CrI, 0.94-2.00), 1.36 (95% CrI, 1.13-1.76), and 1.41 (95% CrI, 1.20-1.71), respectively. Stratification of studies had little effect on Bayesian OR estimates, with only small differences in the stratified ORs observed across population (for beta-blockers and neuroleptics and antipsychotics) and study type (for sedatives and hypnotics, benzodiazepines, and narcotics). An increased likelihood of falling was estimated for the use of sedatives and hypnotics, neuroleptics and antipsychotics, antidepressants, benzodiazepines, and nonsteroidal anti-inflammatory drugs in studies considered to have "good" medication and falls ascertainment. The use of sedatives and hypnotics, antidepressants, and benzodiazepines demonstrated a significant association with falls in elderly individuals.
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            STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation

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              Prescription Opioid Analgesics Commonly Unused After Surgery

              Prescription opioid analgesics play an important role in the treatment of postoperative pain; however, unused opioids may be diverted for nonmedical use and contribute to opioid-related injuries and deaths.
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                Author and article information

                Journal
                British Journal of Clinical Pharmacology
                Br J Clin Pharmacol
                Wiley
                03065251
                June 2018
                June 2018
                April 16 2018
                : 84
                : 6
                : 1354-1363
                Affiliations
                [1 ]School of Pharmacy; Royal College of Surgeons; Ireland Dublin Ireland
                [2 ]School of Pharmacy and Pharmaceutical Sciences; Trinity College; Dublin Ireland
                [3 ]Population Health Sciences Division; Royal College of Surgeons; Ireland Dublin Ireland
                [4 ]Department of General Practice; University College Cork; Cork Ireland
                Article
                10.1111/bcp.13570
                5980334
                29488252
                1c4bc4b1-885b-4bd0-b705-529398a56a76
                © 2018

                http://doi.wiley.com/10.1002/tdm_license_1.1

                http://onlinelibrary.wiley.com/termsAndConditions#vor

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