Intervention Aims to Improve Benzodiazepine Prescribing Practices in Nursing Homes

Benzodiazepines and related drugs are often prescribed for about half of residents of nursing homes, with long-acting benzodiazepines being prescribed to around 10% of residents—despite their well-known deleterious effects.

A group of French researchers aimed to investigate whether a general intervention on quality of care led to discontinuation of benzodiazepines and to examine which nursing home–related factors were associated in changes in benzodiazepine use. The intervention was based on a geriatric education with nursing home staff on several quality indicators of care, including appropriate prescriptions. All participating nursing homes received an initial and 18-month audit regarding drug prescriptions and other quality of care variables, and the intervention group was provided with feedback on the audit with the aim of improving its performance on the quality indicators. The analysis included 3973 residents from 163 nursing homes in France.

Higher reductions were observed in the intervention group than in the control group in overall benzodiazepine use (-2.8% vs -1.5%) and long-acting benzodiazepine use (-3.7% vs -3.5%), although these differences were not statistically significant. Additionally, a smaller percentage of residents in the intervention group (16.7%) became new users of benzodiazepine by the 18-month follow up, versus 19.4% of residents in the control group. Similar percentages of residents in the intervention group (18.4%) and the control group (19.7%) discontinued benzodiazepine during the study.

Variables related to the nursing homes themselves were evaluated in connection with benzodiazepine use. These included the amount of staff, the ratio of staff to residents, the presence of an EMR system, the presence of a 30-day prescription re-evaluation program, and the presence of an on-site pharmacy and pharmacists. Although no structural or organization NH-related variables were found to be predictive of discontinuation or new use of benzodiazepines, hospitalization in the last 12 months and initial use of meprobamate increased the likelihood of becoming a new user of benzodiazepines.

The authors supposed that the intervention may have failed to have a significant effect due to its design: the feedback given to nursing home staff, and the strategies offered to act on this feedback, were very general. The authors suggested that more individualized feedback and proposed strategies tailored to the particular situations in each nursing home may have been more effective.

The study was published in the British Journal of Pharmacology (doi:10.1111/bcp.12847).—Kara Rosania