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      Patterns of benzodiazepine prescription among older adults in Switzerland: a cross-sectional analysis of claims data

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          Abstract

          Objective

          This study aimed to examine the prevalence and determinants of benzodiazepine prescription among older adults in Switzerland, and analyse association with hospitalisation and costs.

          Design

          Retrospective analysis of claims data.

          Setting

          The study was conducted in nine cantons in Switzerland.

          Participants

          Older adults aged 65 years and older enrolled with a large Swiss health insurance company participated in the study.

          Primary and secondary outcome measures

          The primary outcome was prevalence of benzodiazepine prescription. The secondary outcomes were (1) determinants of any benzodiazepine prescription; (2) the association between any prescription and the probability of hospitalisation for trauma and (3) the association between any prescription and total healthcare expenditures.

          Results

          Overall, 69 005 individuals were included in the study. Approximately 20% of participants had at least one benzodiazepine prescription in 2017. Prescription prevalence increased with age (65–69: 15.9%; 70–74: 18.4%; 75–80: 22.5%; >80: 25.8%) and was higher in women (25.1%) compared with men (14.6%). Enrollees with the highest deductible of Swiss Francs (CHF) 2500 were 70% less likely to receive a prescription than enrollees with the lowest deductible of CHF 300 (adjusted OR=0.29, 95% CI 0.24 to 0.35).

          Individuals with at least one prescription had a higher probability of hospitalisation for trauma (OR=1.31, 95% CI 1. 20 to 1.1.44), and 70% higher health care expenditures (β=0.72, 95% CI 0. 67 to 0.77). Enrollees in canton Valais were three times more likely to receive a prescription compared to enrollees from canton Aargau (OR=2.84, 95% 2.51 to 3.21).

          Conclusions

          The proportion of older adults with at least one benzodiazepine prescription is high, as found in the data of one large Swiss health insurance company. These enrollees are more likely to be hospitalised for trauma and have higher healthcare expenditures. Important differences in prescription prevalence across cantons were observed, suggesting potential overuse. Further research is needed to understand the drivers of variation, prescription patterns across providers, and trends over time.

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          Most cited references43

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          Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts.

          Medication toxic effects and drug-related problems can have profound medical and safety consequences for older adults and economically affect the health care system. The purpose of this initiative was to revise and update the Beers criteria for potentially inappropriate medication use in adults 65 years and older in the United States. This study used a modified Delphi method, a set of procedures and methods for formulating a group judgment for a subject matter in which precise information is lacking. The criteria reviewed covered 2 types of statements: (1) medications or medication classes that should generally be avoided in persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available and (2) medications that should not be used in older persons known to have specific medical conditions. This study identified 48 individual medications or classes of medications to avoid in older adults and their potential concerns and 20 diseases/conditions and medications to be avoided in older adults with these conditions. Of these potentially inappropriate drugs, 66 were considered by the panel to have adverse outcomes of high severity. This study is an important update of previously established criteria that have been widely used and cited. The application of the Beers criteria and other tools for identifying potentially inappropriate medication use will continue to enable providers to plan interventions for decreasing both drug-related costs and overall costs and thus minimize drug-related problems.
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            Development of a rational scale to assess the harm of drugs of potential misuse.

            Drug misuse and abuse are major health problems. Harmful drugs are regulated according to classification systems that purport to relate to the harms and risks of each drug. However, the methodology and processes underlying classification systems are generally neither specified nor transparent, which reduces confidence in their accuracy and undermines health education messages. We developed and explored the feasibility of the use of a nine-category matrix of harm, with an expert delphic procedure, to assess the harms of a range of illicit drugs in an evidence-based fashion. We also included five legal drugs of misuse (alcohol, khat, solvents, alkyl nitrites, and tobacco) and one that has since been classified (ketamine) for reference. The process proved practicable, and yielded roughly similar scores and rankings of drug harm when used by two separate groups of experts. The ranking of drugs produced by our assessment of harm differed from those used by current regulatory systems. Our methodology offers a systematic framework and process that could be used by national and international regulatory bodies to assess the harm of current and future drugs of abuse.
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              Modeling Health Care Expenditures and Use

              Health care expenditures and use are challenging to model because these dependent variables typically have distributions that are skewed with a large mass at zero. In this article, we describe estimation and interpretation of the effects of a natural experiment using two classes of nonlinear statistical models: one for health care expenditures and the other for counts of health care use. We extend prior analyses to test the effect of the ACA's young adult expansion on three different outcomes: total health care expenditures, office-based visits, and emergency department visits. Modeling the outcomes with a two-part or hurdle model, instead of a single-equation model, reveals that the ACA policy increased the number of office-based visits but decreased emergency department visits and overall spending.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2020
                6 January 2020
                : 10
                : 1
                : e031156
                Affiliations
                [1 ] departmentCentre for Primary Care and Public Health (Unisanté) , University of Lausanne , Lausanne, Switzerland
                [2 ] Groupe Mutuel , Martigny, Switzerland
                [3 ] Swiss Tropical and Public Health Institute , Basel, Switzerland
                [4 ] departmentDepartment of Internal Medicine , Lausanne University Hospital , Lausanne, Vaud, Switzerland
                Author notes
                [Correspondence to ] Professor Joachim Marti; joachim.marti@ 123456unisante.ch
                Author information
                http://orcid.org/0000-0002-5716-4693
                http://orcid.org/0000-0003-1672-3644
                http://orcid.org/0000-0001-5763-3704
                Article
                bmjopen-2019-031156
                10.1136/bmjopen-2019-031156
                6955498
                31911512
                df0f0f5d-482c-40a0-a441-fe307b64b4ba
                © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 22 April 2019
                : 04 November 2019
                : 06 November 2019
                Funding
                Funded by: Swiss Medical Board.;
                Award ID: N/A
                Categories
                Addiction
                1506
                1681
                Original research
                Custom metadata
                unlocked

                Medicine
                benzodiazepine use,prescription,older adults,claims data,hospitalisations,costs
                Medicine
                benzodiazepine use, prescription, older adults, claims data, hospitalisations, costs

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