背景:苯二氮卓类药物通常用于治疗焦虑和失眠,但是长期使用与依赖性的发展有关,容忍度,和认知能力下降,尤其是老年人。这项研究旨在调查消费模式和与初级卫生保健中苯二氮卓类药物处方不当相关的因素。
方法:这是一项横断面分析研究,使用地西泮的配药记录,氯硝西泮,和2018年至2022年之间巴西城市公共药房的硝西epa。苯二氮卓类药物消耗的指标为DDD(规定的每日剂量)和DDD/1000PD(每天每1000个群体)。长期/长期使用苯二氮卓类药物被定义为每年消耗至少90DDD和至少2次分配。为了确定长期使用和预测变量之间的关联,采用多变量逻辑回归模型.
结果:共纳入40402名参与者,平均年龄为55岁(SD=0.30),38.5%是老年人。地西泮和硝西泮超过每日推荐剂量。在研究期间,地西泮的消费量有所减少,按DDD/1.000PD计算,而其他苯二氮卓类药物的消费量保持稳定。然而,考虑到过去十年,地西泮的消费量显着增加。29.1%的参与者长期使用,在老年人中患病率很高(其中34.8%是长期使用者),并且年龄增长被确定为长期使用的风险因素。较高的PDDs也与长期使用和老化有关。在此期间使用不同苯二氮卓类药物的参与者长期使用的风险更高。
结论:这些结果为初级卫生保健中使用苯二氮卓类药物的普遍性提供了见解。当局和卫生保健提供者必须采取措施,鼓励逐步停止长期服用苯二氮卓类药物,并采用适当的策略来解决初级卫生保健环境中的焦虑和失眠。
BACKGROUND: Benzodiazepines are frequently prescribed to treat anxiety and insomnia, but long-term use has been associated with the development of dependence, tolerance, and cognitive decline, especially among older adults. This study aimed to investigate the pattern of consumption and factors associated with inappropriate prescribing of benzodiazepines in primary health care.
METHODS: This is a cross-sectional analytical study, using dispensing records of diazepam,
clonazepam, and nitrazepam from public pharmacies in a Brazilian municipality between 2018 and 2022. Metrics for benzodiazepine consumption were DDD (Defined Daily Dose) and DDD/1000PD (per 1000 population per day). Long-term/prolonged benzodiazepine use was defined as consuming at least 90 DDD and at least 2 dispensations per year. To ascertain associations between long-term use and predictor variables, a multivariate logistic regression model was utilized.
RESULTS: A total of 40402 participants were included, with an average age of 55 years (SD = 0.30), 38.5% were older aged. Diazepam and nitrazepam exceeded the daily dose recommended. There was a reduction in diazepam consumption during the study period, as calculated by DDD/1.000PD, while the consumption of other benzodiazepines remained stable. However, a significant increase in diazepam consumption is noted when considering the last decade. Prolonged use was observed in 29.1% of participants, with a significant prevalence among the older people (34.8% of them were long-term users) and advancing age was identified as a risk factor for long-term use. Higher PDDs were also associated with long-term use and aging. Participants who used different benzodiazepines during the period had a higher risk of prolonged use.
CONCLUSIONS: These results provide insights into the prevalence of problematic utilization of benzodiazepines in primary health care. Authorities and health care providers must take steps to encourage gradual cessation of prolonged benzodiazepine prescriptions and the embrace of suitable strategies for addressing anxiety and insomnia within primary health care settings.