Linda Jean Simoni-Wastila

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Effects of state surveillance on new post-hospitalization benzodiazepine use.

Anita K Wagner; Stephen B Soumerai; Fang Zhang; Connie Mah; Linda Simoni-Wastila; Leon Cosler; Thomas Fanning; Peter Gallagher; Dennis Ross-Degnan (Profiled Author: Linda Jean Simoni-Wastila)

Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, USA. anita_wagner@hms.harvard.edu
International journal for quality in health care : journal of the International Society for Quality in Health Care / ISQua 2003;15(5):423-31.

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.

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