Reduction of the burden associated with the prescriptions of sedative-hypnotics in hospitalized older adults

Les données épidémiologiques concernant l’initiation d’hypnosédatifs (HS) chez le sujet âgé hospitalisé, les facteurs de risque associés et l’efficacité des actions de promotion du bon usage sont peu nombreuses. Les objectifs étaient (1) d’évaluer l’incidence des initiations d’HS en hospitalisation aiguë, la proportion de reconduction à la sortie, les facteurs de risque associés (SÉDATIF) et (2) d’identifier/évaluer les interventions de promotion du bon usage des HS décrites dans la littérature (HYPNOREV). Dans l’étude rétrospective multicentrique SÉDATIF, la proportion d’initiations d’HS était de 21,5% à 20 jours. L’HS était reconduit chez 56,0% des patients sortant en Soins de Suite et de Réadaptation (SSR) et 38,7% des sortants à domicile. Aucun facteur de risque d’initiation n’a été mis en évidence. Chez les patients sortant en SSR, l’initiation après 6 jours était protectrice de la reconduction à la sortie (OR = 0,19 ; p = 0,02). La revue systématique HYPNOREV (1980-2015) a permis d’identifier 31 études portant sur des interventions réglementaires ou éducatives de promotion du bon usage des HS. Les interventions éducatives multifacettes impliquant professionnels de santé, patients et utilisant les médias étaient les plus efficaces. De nouvelles études plus robustes étudiant la mise en la place de telles interventions en milieu hospitalier sont nécessaires.Few data exist regarding SHs initiation among hospitalized older patients, associated risk factors and efficiency of interventions promoting their good use. The objectives were (1) to determine the proportion of SH initiation in acute hospitalization units, the proportion of SH renewal at discharge and to study associated risk factors (SÉDATIF) and (2) to identify and assess regulatory and educational interventions designed to improve the appropriate use of SHs (HYPNOREV). In the retrospective multicenter study SÉDATIF, SH initiation occurred in 21.5% of patients 20 days after admission. SH renewal at discharge occurred in 38.7% of patients who had initiated it during their stay and were discharged home and in 56.0% of patients discharged to rehabilitation facilities. No risk factor could be highlighted. SH initiation after the first 6 days was associated with a lower risk of renewal in patients discharged to rehabilitation facilities (OR = 0.19, p = 0.02). Regarding the systematic review of the literature HYPNOREV (1980-2015): 31 studies assessing educational or regulatory interventions were included. Multi-faceted educational interventions reporting the involvement of healthcare professionals and patients and the spread of information through mass media were successful. Further better designed studies are needed to study this type of interventions in the hospital setting

Lutte contre l'iatrogénie liée aux prescriptions d'hypnosédatifs chez le sujet âgé hospitalisé

Few data exist regarding SHs initiation among hospitalized older patients, associated risk factors and efficiency of interventions promoting their good use. The objectives were (1) to determine the proportion of SH initiation in acute hospitalization units, the proportion of SH renewal at discharge and to study associated risk factors (SÉDATIF) and (2) to identify and assess regulatory and educational interventions designed to improve the appropriate use of SHs (HYPNOREV). In the retrospective multicenter study SÉDATIF, SH initiation occurred in 21.5% of patients 20 days after admission. SH renewal at discharge occurred in 38.7% of patients who had initiated it during their stay and were discharged home and in 56.0% of patients discharged to rehabilitation facilities. No risk factor could be highlighted. SH initiation after the first 6 days was associated with a lower risk of renewal in patients discharged to rehabilitation facilities (OR = 0.19, p = 0.02). Regarding the systematic review of the literature HYPNOREV (1980-2015): 31 studies assessing educational or regulatory interventions were included. Multi-faceted educational interventions reporting the involvement of healthcare professionals and patients and the spread of information through mass media were successful. Further better designed studies are needed to study this type of interventions in the hospital setting.Les données épidémiologiques concernant l’initiation d’hypnosédatifs (HS) chez le sujet âgé hospitalisé, les facteurs de risque associés et l’efficacité des actions de promotion du bon usage sont peu nombreuses. Les objectifs étaient (1) d’évaluer l’incidence des initiations d’HS en hospitalisation aiguë, la proportion de reconduction à la sortie, les facteurs de risque associés (SÉDATIF) et (2) d’identifier/évaluer les interventions de promotion du bon usage des HS décrites dans la littérature (HYPNOREV). Dans l’étude rétrospective multicentrique SÉDATIF, la proportion d’initiations d’HS était de 21,5% à 20 jours. L’HS était reconduit chez 56,0% des patients sortant en Soins de Suite et de Réadaptation (SSR) et 38,7% des sortants à domicile. Aucun facteur de risque d’initiation n’a été mis en évidence. Chez les patients sortant en SSR, l’initiation après 6 jours était protectrice de la reconduction à la sortie (OR = 0,19 ; p = 0,02). La revue systématique HYPNOREV (1980-2015) a permis d’identifier 31 études portant sur des interventions réglementaires ou éducatives de promotion du bon usage des HS. Les interventions éducatives multifacettes impliquant professionnels de santé, patients et utilisant les médias étaient les plus efficaces. De nouvelles études plus robustes étudiant la mise en la place de telles interventions en milieu hospitalier sont nécessaires

A systematic review of regulatory and educational interventions to reduce the burden associated with the prescriptions of sedative-hypnotics in adults treated for sleep disorders

<div><p>Background</p><p>The burden of Sedative-Hypnotics (SHs) has been known since the 1980s. Yet, their consumption remains high. A systematic review of the literature should help to assess efficient interventions to improve the appropriate use of SHs in sleep disorders.</p><p>Objectives</p><p>To identify and assess regulatory and educational interventions designed to improve the appropriate use of SHs for insomnia treatment.</p><p>Methods</p><p>We conducted a systematic review of the literature according to PRISMA guidelines. A systematic search covering the period 1980–2015 was carried out in Medline, Web of Science, Embase and PsycInfo. We included studies reporting the implementation of regulatory or educational strategies directed towards patients and/or healthcare professionals to improve the appropriate use of SHs to treat insomnia in the community, hospitals and nursing homes.</p><p>Results</p><p>Thirty-one studies were included: 23 assessed educational interventions (recommendations by mail/email, computer alerts, meetings, mass media campaigns, prescription profile), 8 assessed regulatory interventions (prescription rule restriction, end of reimbursement). The most recent was implemented in 2009. Restrictive prescription rules were effective to reduce the consumption of targeted SHs but led to a switch to other non-recommended SHs. Among educational interventions, only 3 studies out of 7 reported positive results of mono-faceted interventions; whereas, 13 out of the 16 multi-faceted interventions were reported as efficient: particularly, the active involvement of healthcare professionals and patients and the spread of information through mass media were successful. The risk of bias was high for 24 studies (mainly due to the design), moderate for 3 studies and weak for 4 studies.</p><p>Conclusion</p><p>Educational multifaceted studies are presented as the most efficient. But further better designed studies are needed to make evidence-based results more generalizable.</p></div

Sedative-hypnotic initiation and renewal at discharge in hospitalized older patients: an observational study

Abstract Background Sedative-hypnotics (SHs) are widely used in France but there are no available data addressing their prescription specifically in hospitalized older patients. The objective is thus to determine the cumulative incidence of sedative-hypnotic (SH) medications initialized during a hospital stay of older patients, the proportion of SH renewal at discharge among these patients and to study associated risk factors. Methods We conducted a retrospective observational study in six internal medicine units and six acute geriatric units in eight hospitals (France). We included 1194 inpatients aged 65 and older without SH medications prior to hospitalization. Data were obtained from patients’ electronic pharmaceutical records. Primary outcome was the cumulative incidence of SH initiation in the study units. Secondary outcomes were the proportion of SH renewal at discharge and risk factors for SH initiation and renewal at discharge (patient characteristics, hospital organization). A Cox regression model was used to study risk factors for SH initiation. A mixed effects logistic regression was used to study risk factors for SH renewal at discharge. Results SH initiation occurred in 21.5% of participants 20 days after admission. SH renewal at discharge occurred in 38.7% of patients who had initiated it during their stay and were discharged home and in 56.0% of patients discharged to rehabilitation facilities. Neither patients’ characteristics nor hospital organization patterns was associated with SH initiation. SH initiation after the first six days after admission was associated with a lower risk of SH renewal in patients discharged to rehabilitation facilities (OR = 0.19, 95% CI: [0.04–0.80]). Conclusions Hospitalization is a period at risk for SH initiation. The implementation of interventions promoting good use of SHs is thus of first importance in hospitals. Specific attention should be paid to patients discharged to rehabilitation facilities

Representation of study results as a function of study design, type of intervention and risk of bias.

<p>Bold text: Randomized Controlled Trials. Italics: type of intervention.</p

PRISMA flow diagram for the systematic review of regulatory and educational interventions to reduce the burden associated with the prescriptions of sedative-hypnotics in adults treated for sleep disorders.

<p>PRISMA flow diagram for the systematic review of regulatory and educational interventions to reduce the burden associated with the prescriptions of sedative-hypnotics in adults treated for sleep disorders.</p

Data items collected for studies included in the review.

<p>Data items collected for studies included in the review.</p

Risk of bias across studies (all designs confounded, among RCTs only and among BA studies only) according to the Quality Assessment Tool for Quantitative Studies.

<p>Risk of bias across studies (all designs confounded, among RCTs only and among BA studies only) according to the Quality Assessment Tool for Quantitative Studies.</p