Provider Patient-Sharing Networks and Multiple-Provider Prescribing of Benzodiazepines

Ong, Mei Sing; Olson, Karen L.; Cami, Aurel; Liu, Chunfu; Tian, Fang; Selvam, Nandini; Mandl, Kenneth D.

doi:10.1007/s11606-015-3470-8

J GEN INTERN MED

2015

DOI: 10.1007/s11606-015-3470-8

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Provider Patient-Sharing Networks and Multiple-Provider Prescribing of Benzodiazepines

Mei Sing Ong

Karen L. Olson

Aurel Cami

et al.

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Cited by 39 publications

(52 citation statements)

References 40 publications

(41 reference statements)

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“…The rate at which patients received benzodiazepine prescriptions in the Ong et al study 1 (5.1 % of total patients) is similar to that in a recent study by Olfson et al, 6 which estimated that 5.2 % of adults in the United States in 2008 received prescriptions for benzodiazepines. Interestingly, Olfson et al found that most benzodiazepine prescribing was done by non-psychiatrists.…”

supporting

confidence: 83%

“…Published online October 13, 2015 et al 1 found that among patients with benzodiazepine prescriptions (5.1 % of total patients in the study sample), multiple prescriptions were found among 21 % (1.1 % of total patients) and overlapping prescriptions among 3.8 % (0.2 % of total patients). Given the relatively low base rates of these prescribing practices, other approaches are clearly needed to improve medication safety.…”

mentioning

confidence: 92%

“…T he study by Ong et al 1 reported in this issue of JGIM represents a major step forward toward improving our understanding of benzodiazepine prescribing and potential targets for improving benzodiazepine prescribing practices. The authors employed social network analysis to model select provider networks and relationships with benzodiazepine prescribing.…”

mentioning

confidence: 99%

“…A previous study 2 drawing from the same overall data used by Ong et al 1 found a great deal of variability in provider patient-sharing networks. The authors commented that BCohesion among providers is not the norm.…”

mentioning

confidence: 99%

“…One caveat should be kept in mind when interpreting the results of the study by Ong et al 1 While the authors did not find the expected association between comorbidity and overlapping benzodiazepine prescriptions, they examined only medical comorbidity and not mental health comorbidity, and only patients between the ages 18 and 64 were included. Given that the study by Olfson et al 6 suggests that the highest rates of benzodiazepine use were among 65-to 80-year-olds, Ong et al's study excludes an important sub-population that may be at greater risk for overlapping benzodiazepine prescriptions, and may underestimate the potential effects of medical comorbidities.…”

mentioning

confidence: 99%

See 4 more Smart Citations

The Future of Social Network Analysis of Health Care System Data: Promise and Concerns

Oliva

2015

J GEN INTERN MED

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supporting

confidence: 83%

mentioning

confidence: 92%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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The Future of Social Network Analysis of Health Care System Data: Promise and Concerns

Oliva

2015

J GEN INTERN MED

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Who diagnosed and prescribed what? Using provider details to inform observational research

Bushnell

Stürmer

Mack

et al. 2018

Pharmacoepidemiology and Drug

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Purpose. To describe how often patients with depression initiating antidepressants receive their depression diagnosis and prescriptions from the same provider and, when simultaneously initiating benzodiazepines, how often both prescriptions come from the same provider. Methods. Using US healthcare claims data, we created a cohort of adults (18-64 years) with a depression diagnosis who initiated antidepressants. We examined concordance by provider specialty and provider identifier between a) the first antidepressant prescription fill and most proximal depression diagnosis, and b) the initial antidepressant and benzodiazepine prescription fills among simultaneous benzodiazepine and antidepressant initiators. Results. Among 245,166 antidepressant initiators with a recent depression diagnosis (female=67%; median age=39), the specialty of the provider assigning the depression diagnosis matched the antidepressant prescriber’s specialty in 94% of cases with known provider details (provider identifier concordance=93%). Concordance was higher for adults diagnosed by a general practitioner (98%) or psychiatrist (92%) than for those diagnosed by a psychologist (74%). In simultaneous new users of antidepressants and benzodiazepines (n=19,371), both prescriptions were issued by the same provider specialty and provider identifier 94% and 93% of the time, respectively. Conclusions. The vast majority of patients who received antidepressant prescriptions and depression diagnoses appear to have received both diagnosis and antidepressants from the same provider, suggesting that when antidepressants are issued around the time a patient is diagnosed with depression, the antidepressant was likely prescribed for depression. In addition, the great majority of patients who simultaneously initiate benzodiazepines appear to do so under the direction of one provider.

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Factors associated with long-term benzodiazepine and Z-drug use across the lifespan and 5-year temporal trajectories among incident users: a Swedish nationwide register-based study

Isomura

Wang

Chang

et al. 2023

Eur J Clin Pharmacol

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Purpose Despite being discouraged by guidelines, long-term use of benzodiazepines and related Z-drugs (BZDR) remains frequent in the real-world. An improved understanding of factors associated with the transition from new to long-term BZDR use and of temporal BZDR use trajectories is needed. We aimed to assess the proportion of long-term BZDR use (> 6 months) in incident BZDR-recipients across the lifespan; identify 5-year BZDR use trajectories; and explore individual characteristics (demographic, socioeconomic and clinical) and prescribing-related factors (pharmacological properties of the initial BZDR, prescriber’s healthcare level, and concurrent dispensing of other medications) associated with long-term BZDR use and distinct trajectories. Methods Our nationwide register-based cohort included all BZDR-recipients in Sweden with first dispensation in 2007–2013. Trajectories of BZDR use days per year were built using group-based trajectory modelling. Cox regression and multinomial logistic regression were fitted to assess the predictors of long-term BZDR use and trajectories’ membership. Results In 930,465 incident BZDR-recipients, long-term use increased with age (20.7%, 41.0%, and 57.4% in 0–17, 18–64, and ≥ 65-year-olds, respectively). Four BZDR use trajectories emerged, labelled ‘discontinued’, ‘decreasing’, ‘slow decreasing’ and ‘maintained’. The proportion of the ‘discontinued’ trajectory members was the largest in all ages, but reduced from 75.0% in the youths to 39.3% in the elderly, whereas the ‘maintained’ increased with age from 4.6% to 36.7%. Prescribing-related factors, in particular multiple BZDRs at initiation and concurrent dispensing of other medications, were associated with increased risks of long-term (vs short-term) BZDR use and developing other trajectories (vs ‘discontinued’) in all age groups. Conclusions The findings highlight the importance of raising awareness and providing support to prescribers to make evidence-based decisions on initiating and monitoring BZDR treatment across the lifespan.

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Provider Patient-Sharing Networks and Multiple-Provider Prescribing of Benzodiazepines

Cited by 39 publications

References 40 publications

The Future of Social Network Analysis of Health Care System Data: Promise and Concerns

The Future of Social Network Analysis of Health Care System Data: Promise and Concerns

Who diagnosed and prescribed what? Using provider details to inform observational research

Factors associated with long-term benzodiazepine and Z-drug use across the lifespan and 5-year temporal trajectories among incident users: a Swedish nationwide register-based study

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