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Can clinical practice indicator relating to long-acting benzodiazepine use in the elderly be easily generated in a hospital setting?

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Background

To improve the appropriate use of long-acting benzodiazepine (la.bzd) prescriptions in the elderly, the Haute Autorité de Santé (HAS) has developed clinical practice indicators (CPI). The alert indicator (AI) evaluates the prevalence of la.bzd prescription among older people. The mastering indicator (MI) corresponds to the prevalence of elderly with a justified, i.e., appropriate, la.bzd prescription among all the elderly with la.bzd prescriptions.

Objective

The objective of this study was to test the feasibility of routine generation of CPI regarding la.bzd prescriptions among the elderly in the hospital setting.

Design

This was a retrospective study.

Setting

The study was conducted in two university hospitals located in Paris.

Subject

Eligible cases were patients aged 65 years and older who were hospitalized in acute care units from January to June 2014.

Method

The AI calculation was based on information extracted from medical databases from these hospitals. The appropriateness of la.bzd prescription was assessed by a physician and a pharmacist and was based on review of computerized patient records and prescriptions, using an ad hoc algorithm. The MI was then calculated. Variation in the level of indicators was explored according to the characteristics of patients and of their hospitalization using chi2 test. Factors associated with a potentially inappropriate prescription (PIP) of la.bzd were studied using univariate and multivariate logistic regression.

Result

Among the 4167 patients included in the study, 362 had la.bzd prescriptions, i.e., the AI was 9%. Prescriptions were found to be appropriate for 83 patients, i.e., the MI was 23% and PIP was 77%. The MI varied between 13 and 31% according to characteristics of patients and of hospitalization. In multivariate analysis, factors associated with PIP were age, number of comorbidities, type of care unit, and concurrent prescription of a neuroleptic or hypnotic.

Conclusion

Generation of the AI was routinely possible but only for acute care units with computerized prescriptions, corresponding to 78% of patients. Production of the MI has required medical record review for all patients with a la.bzd prescription and cannot be automated. However, difficulties in generating the MI have identified areas for significant improvement. Moreover, strategies to improve the care of older people with a la.bzd prescription could be targeted using characteristics of patients and of hospitalization associated with PIP. The future deployment of a single electronic medical record in all care departments would make it easier to mine the data and make possible automated production of CPI.

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Acknowledgements

The authors want to thank Maria Ramanisamanana and Anne Guillard for their precious technical help in Phedra database extraction. We want to thank Dr. Juliette Oliary for her advices regarding structure and quality of data in Phedra. We also thank Judith Armbruster and Mary Alice Parsons for their skillful assistance in reviewing the language of this manuscript.

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Authors and Affiliations

  1. Public Health and Health Economics Department, AP-HP, Saint-Louis-Lariboisière Fernand-Widal Hospital Group, Paris, France

    Badria Kadri, Christelle Duteil, Christophe Segouin & Pénélope Troude

  2. Pharmacy, AP-HP, Saint-Louis-Lariboisière Fernand-Widal Hospital Group, Paris, France

    Badria Kadri & Hélène Barreteau

  3. Geriatric Department, AP-HP, Saint-Louis-Lariboisière Fernand-Widal Hospital Group, Paris, France

    Antonio Teixeira & Annabelle Tan

  4. INSERM UMR-S942, PRES Sorbonne Paris Cité, University Paris Diderot, Paris, France

    Antonio Teixeira

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  1. Badria Kadri
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Correspondence to Badria Kadri.

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Kadri, B., Teixeira, A., Duteil, C. et al. Can clinical practice indicator relating to long-acting benzodiazepine use in the elderly be easily generated in a hospital setting?. Eur J Clin Pharmacol 74, 233–241 (2018). https://doi.org/10.1007/s00228-017-2371-7

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  • DOI: https://doi.org/10.1007/s00228-017-2371-7

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