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1. The attendee will be able to explain and recognize patient-level factors associated with benzodiazepine and antipsychotic prescribing in hospice
2. The attendee will be able to explain and recognize hospice agency-level factors associated with benzodiazepine and antipsychotic prescribing in hospice
Benzodiazepines and antipsychotics are routinely prescribed for symptom management in hospice, but they are not without important risks. An understanding of the factors associated with prescribing of these medications is important.
Examine patient- and hospice-agency-level characteristics associated with incident prescribing of benzodiazepines and antipsychotics in hospice.
Retrospective cohort study of a 20% sample of Medicare beneficiaries newly enrolled in hospice from 2014 to 2016, restricting to those without benzodiazepine (N = 169,688) or antipsychotic (N = 190,441) prescription fills in the 6 months before hospice enrollment. The primary outcome was incident (i.e., new) prescribing of a benzodiazepine or antipsychotic in hospice. A series of multilevel Cox regression models with random intercepts for hospice agency were fit to examine the association of incident benzodiazepine and antipsychotic prescribing with patient and hospice agency characteristics.
A total of 91,728 (54.1%) and 58,175 (30.5%) hospice beneficiaries were newly prescribed a benzodiazepine or antipsychotic across 4,347 hospice agencies. The prescribing rate of the hospice agency was the strongest independent predictor of incident psychotropic prescribing. Compared to those in agencies in the lowest quartile of benzodiazepine prescribing, those in agencies in the highest quartile were 10.7 times more likely to be newly prescribed a benzodiazepine (adjusted hazard ratio [AHR] 10.7, 95% CI 10.1-11.3). Those in agencies in the highest quartile of antipsychotic prescribing were 51.7 times more likely to receive an antipsychotic (AHR 51.7, 95% CI 44.3-60.4) compared to those in the lowest quartile. Results remained consistent, accounting for comfort kit prescribing.
Enrollment in a high-prescribing hospice agency was the characteristic most strongly associated with incident prescribing of benzodiazepines or antipsychotics, exceeding every other patient-level factor.
While it is unclear what the “right” level of prescribing is in hospice, this significant variation may reflect a strong local prescribing culture across individual hospice agencies.
© 2022 Published by Elsevier Inc.