Asian journal of psychiatry · 2019
Deprescribing of benzodiazepines and Z-drugs amongst the psychiatric patients of a tertiary care Hospital.
Clinical StudyСтатьяНазвание и аннотация: Перевод в очереди
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Shilpa Halumatha Surendra Shree, Kumar N Naveen, Maheswari Eswaran, Virupaksha Harave Shanmugam, Subeesh Viswam, Saraswathy Ganesan Rajalekshmi, Kunnavil Radhika
Аннотация
BACKGROUND: In current clinical practice, regardless of the clinical guidelines, BZDs and Z drugs are used beyond the period of indication, resulting in undesirable effects. This study aimed to assess feasibility of deprescribing amongst patients utilizing BZDs and Z drugs inappropriately for longer duration than the prescribed period. The study also analysed the Quality of Sleep (QoS) and Cost Savings incurred amongst deprescribed patients.
METHODS: It was a prospective interventional study conducted in IP and OP settings of Psychiatry Department, Bangalore, India. Based on inclusion criteria, 109 patients were recruited for the study for a period of 7 months. Deprescribing was advised to inappropriate BZD and Z-drug users by clinical pharmacist after discussing with the prescribing psychiatrist. The patients were followed-up twice in a month after deprescribing. QoS was assessed by using Pittsburg Sleep Quality Index (PSQI) scale. The total medications cost incurred per patient/month before and after the intervention among both the groups was measured.
RESULTS: Post-intervention, 40(30.69%) BZD users were deprescribed i.e, either dose tapered 6(5.5%), completely ceased 27(24.8%) or on si opus sit (SOS) BZDs prescription 7(6.4%). A majority of 44(40.36%) patients continued BZDs according to the algorithm. Clonazepam 35(87.5%) was the most deprescribed BZD. Deprescribing of BZDs showed an association with QoS of patients, p-value (<0.05). A statistically significant cost reduction was observed after deprescribing BZDs, (Z = 5.465, p=<0.001).
DISCUSSION: Deprescribing BZDs was associated with decline in its usage; implementing deprescribing practice amongst the inappropriate BZD users is feasible, provides an improved QoS and an economic benefit.
METHODS: It was a prospective interventional study conducted in IP and OP settings of Psychiatry Department, Bangalore, India. Based on inclusion criteria, 109 patients were recruited for the study for a period of 7 months. Deprescribing was advised to inappropriate BZD and Z-drug users by clinical pharmacist after discussing with the prescribing psychiatrist. The patients were followed-up twice in a month after deprescribing. QoS was assessed by using Pittsburg Sleep Quality Index (PSQI) scale. The total medications cost incurred per patient/month before and after the intervention among both the groups was measured.
RESULTS: Post-intervention, 40(30.69%) BZD users were deprescribed i.e, either dose tapered 6(5.5%), completely ceased 27(24.8%) or on si opus sit (SOS) BZDs prescription 7(6.4%). A majority of 44(40.36%) patients continued BZDs according to the algorithm. Clonazepam 35(87.5%) was the most deprescribed BZD. Deprescribing of BZDs showed an association with QoS of patients, p-value (<0.05). A statistically significant cost reduction was observed after deprescribing BZDs, (Z = 5.465, p=<0.001).
DISCUSSION: Deprescribing BZDs was associated with decline in its usage; implementing deprescribing practice amongst the inappropriate BZD users is feasible, provides an improved QoS and an economic benefit.