International Journal for Quality in Health Care 15:423-431 (2003)
© 2003 International Society for Quality in Health Care
Effects of state surveillance on new post-hospitalization benzodiazepine use
1 Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA,2 Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD,3 Albany College of Pharmacy, Albany, NY,4 Management Reports and Research Unit, Office of Medicaid Management, New York State Department of Health, Albany, NY, USA
Background. Benzodiazepines (BZD) effectively treat anxiety and insomnia accompanying major health events, including hospitalizations. Prescribing regulations to decrease BZD misuse may negatively impact therapeutic uses.
Objective. To assess the impact of a Triplicate Prescription Program (TPP) on initiation of post-hospitalization BZD prescribing, both overall and among cardiac and cancer patients in the United States.
Design. Interrupted time-series of post-hospitalization BZD dispensing events to enrollees in the US Medicaid program in the states of New York (intervention group) and New Jersey (control group), before and after implementation of a TPP.
Study participants. Community-dwelling Medicaid enrollees in New York State (n = 67 962) and New Jersey (n = 71 701), hospitalized between 1 January 1988 and 30 November 1990.
Intervention. The New York State TPP, implemented on 1 January 1989, requires physicians to prescribe BZD on triplicate prescription forms for state surveillance.
Outcome measures. Rates and duration of new post-hospitalization use of BZD and substitute medications.
Results. Overall, a sudden and sustained 63.5% decrease [95% confidence interval (CI) -58.6% to -68.3%] in new post-hospitalization BZD dispensing—from a baseline rate of 44 discharges with BZD dispensing per 1000 discharges per month—followed the TPP in New York State, without discontinuity in the control state. Patients hospitalized for acute ischemic cardiac events experienced a 72.5% reduction (95% CI -55.5% to -89.4%), and cancer patients a 69.4% reduction (95% CI -36.7% to -100.0%). The TPP did not preferentially reduce BZD use lasting >2 months. Increased substitute use did not offset reductions in BZD use.
Conclusions. By decreasing new short-term post-hospitalization BZD use, the New York State TPP also had unintended effects.
Keywords: benzodiazepines, drug regulation, longitudinal studies, pharmaceutical policy
Address reprint requests to Anita K. Wagner, Pharm D, DPH, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, USA. E-mail: anita_wagner{at}hms.harvard.edu
Accepted for publication June 2, 2003.
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