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Effects of a geriatric intervention aiming to improve quality care in nursing homes on benzodiazepine use and discontinuation.

Abstract：

BACKGROUND:Benzodiazepines and "Z drugs" are often prescribed in residents of nursing homes (NH) despite their well-known deleterious effects. We aimed to investigate if a general intervention on quality of care led to discontinuation of benzodiazepine, and to examine which NH-related factors were associated in change of benzodiazepines use. METHODS:IQUARE is a quasi-experimental study, investigating the impact of an intervention based on a geriatric education with NH staff on several quality indicators of care (including appropriate prescriptions). All participating NH received an initial and 18-month audit regarding drug prescriptions and other quality of care variables. The analysis included 3973 residents, 2151 subjects (mean age: 84.6 ± 8.5 years; 74.3% women) in the control group and 1822 (mean age: 85.5 ± 8.1 years; 77.4% women) in the intervention group. Outcomes at 18 months were benzodiazepines use, long-acting benzodiazepines use, new-use of benzodiazepines, and discontinuation. The effect of the intervention was investigated using mixed-effect logistic regression models, including NH variables and residents' health status as confounders. RESULTS:Higher reductions in benzodiazepine use (-2.8% vs. -1.5%) and long-acting benzodiazepine (-3.7% vs. -3.5%) were observed in intervention group, but not statistically significant. None of the structural and organisational NH-related variables predicted either discontinuation or new-use of benzodiazepines; hospitalisations and initial use of meprobamate increased the likelihood of becoming a new-user of benzodiazepines. Multivariate analysis suggested that living in a particular NH could affect benzodiazepines discontinuation. CONCLUSIONS:A general intervention designed to improve overall NH quality indicators did not succeed in reducing benzodiazepines use. External factors interfered with the intervention. Further studies are needed to examine which NH-related aspects could impact benzodiazepines discontinuation.

journal_name

Br J Clin Pharmacol

journal_title

British journal of clinical pharmacology

authors

de Souto Barreto P,Lapeyre-Mestre M,Cestac P,Vellas B,Rolland Y

doi

10.1111/bcp.12847

subject

Has Abstract

pub_date

2016-04-01 00:00:00

pages

759-67

issue

eissn

0306-5251

issn

1365-2125

journal_volume

pub_type

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Effects of a geriatric intervention aiming to improve quality care in nursing homes on benzodiazepine use and discontinuation.