Artikel
The influence of hospitalisation on the initiation of hypnotics and sedatives – An observation study based on pharmacy claims data
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Autoren
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Thomas Grimmsmann
- Referat Arzneimittel & Methoden - Medizinischer Dienst der Krankenversicherung M-V e. V., Schwerin, Germany
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Thomas Fiß
- AOK Nordost - die Gesundheitskasse; UB Arzneimittelversorgung, Potsdam, Germany
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Wolfgang Himmel
- Institut für Allgemeinmedizin - Universitätsmedizin Göttingen, Göttingen, Germany
| Veröffentlicht: | 18. November 2014 |
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Gliederung
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Background: It is well-known that hospitalisation exerts a marked influence on drug therapy in ambulatory care. This influence may be also true in the case of hypnotics and sedatives but this has not been investigated on a large and valid basis. The aim of this study was to assess the overall influence of hospitalisation on the prescription of hypnotics and sedatives in outpatient care, focussing on the role of different hospitals and different wards.
Materials and Methods: This follow-up study compared drugs prescribed in the primary care sector before and after hospitalisation for patients of a large German statutory health insurance. The drugs under study were benzodiazepines and Z drugs (ATC codes N05BA, N05CD, N05CF). The prescriptions for each patient were analysed for a 3-month period, i. e. ≤ 91 days before and after hospitalisation, respectively.
Results: Prescription data from 115,976 patients in 3 federal states of Germany were available. The patients had been hospitalized in 30 different hospitals, 7 of them specialized in geriatric medicine. A total of 4,849 (4.2%) patients received one or more of the target drugs before admission. In 2,370 cases, these drugs were continued after discharge; 3,490 patients started with at least a new target drug after discharge resulting in 5,860 who received at least one target drug after discharge. This was a net increase of 21%, compared to the time before admission. The rates varied between the 30 hospitals, ranging between a decrease of 12% and an increase of 53%. The range was nearly the same when excluding the geriatric hospitals. Large differences could also be detected between the different departments. After being discharged from a department of internal medicine, benzodiazepines and Z drugs increased, on average, by 31%, in the case of geriatric departments by 21%; in contrast the drugs were 9% lower after discharge from a psychiatric ward.
Conclusion: Although hypnotics and sedatives should be prescribed very cautiously, not the least because of their addictive potential, the risk of falls and hip fractures or the impairment of mental function and memory in older people, hospitals may be one factor in initiating the prescription of these drugs. Before we draw any valid conclusions, limitations in the database and in our data analysis should be carefully considered.
