Journal article
Patient and Facility Characteristics Associated With Benzodiazepine Prescribing for Veterans With PTSD
Psychiatric services (Washington, D.C.), Vol.64(2), pp.149-155
2013
DOI: 10.1176/appi.ps.201200267
PMID: 23154834
Abstract
Objective
Practice guidelines used in the Veterans Health Administration (VHA) caution against benzodiazepine use by veterans with posttraumatic stress disorder (PTSD) because of inefficacy and safety concerns. Although use has declined, the VHA prescription rate is ≥30% nationally. To inform intervention design, this study examined patient- and facility-level correlates of benzodiazepine prescribing.
Methods
This cross-sectional study used 2009 national administrative VHA data to identify veterans with PTSD, benzodiazepine prescriptions, and various patient and facility characteristics. Correlates of benzodiazepine prescribing were determined with multivariable hierarchical logit models.
Results
Among 137 VHA facilities, 495,309 veterans with PTSD were identified, and 150,571 (30.4%) received a benzodiazepine prescription. Patient characteristics independently associated with benzodiazepine use included female gender, age ≥30 years, rural residence, service-connected disability ≥50%, Vietnam-era service, duration of PTSD diagnosis, and a comorbid anxiety disorder. However, case-mix adjustment for these variables accounted for <1% of prescribing variation. Facility characteristics independently associated with higher use included lower PTSD visit volume, higher rates of duplicate prescribing (concurrent use of more than one drug from a class), and lower rates of trazodone prescribing. These findings were corroborated in replication analyses.
Conclusions
The ultimate goal is to ensure consistent access to guideline-concordant PTSD treatment across the VHA. This study furthered this objective by identifying characteristics associated with benzodiazepine prescribing. Findings suggest that interventions could be designed to target individual high-volume prescribers or influence prescribing culture at the facility level.
Details
- Title: Subtitle
- Patient and Facility Characteristics Associated With Benzodiazepine Prescribing for Veterans With PTSD
- Creators
- Brian C LUND - Center for Comprehensive Access and Delivery Research and Evaluation and the Veterans Rural Health Resource Center―Central Region, Iowa City Veterans Affairs (VA) Health Care System, Mailstop 152, 601 Hwy. 6 W., Iowa City, IA 52246, United StatesNancy C BERNARDY - National Center for PTSD, White River Junction VA Medical Center, White River Junction, Vermont, and with the Department of Psychiatry, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire, United StatesMary VAUGHAN-SARRAZIN - Center for Comprehensive Access and Delivery Research and Evaluation and the Veterans Rural Health Resource Center―Central Region, Iowa City Veterans Affairs (VA) Health Care System, Mailstop 152, 601 Hwy. 6 W., Iowa City, IA 52246, United StatesBruce ALEXANDER - Department of Pharmacy Services, Iowa City VA Health Care System, Iowa City, United StatesMatthew J FRIEDMAN - National Center for PTSD, White River Junction VA Medical Center, White River Junction, Vermont, and with the Department of Psychiatry, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire, United States
- Resource Type
- Journal article
- Publication Details
- Psychiatric services (Washington, D.C.), Vol.64(2), pp.149-155
- Publisher
- American Psychiatric Association; Arlington, VA
- DOI
- 10.1176/appi.ps.201200267
- PMID
- 23154834
- ISSN
- 1075-2730
- eISSN
- 1557-9700
- Language
- English
- Date published
- 2013
- Academic Unit
- Pharmacy; Psychiatry; Health Management and Policy; Epidemiology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984063205102771
Metrics
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