title: Effects of state surveillance on new post-hospitalization benzodiazepine use.
abstract: BACKGROUND
  Benzodiazepines (BZD) effectively treat anxiety and insomnia accompanying major health events, including hospitalizations. Prescribing regulations to decrease BZD misuse may negatively impact therapeutic uses.
  
  
  OBJECTIVE
  To assess the impact of a Triplicate Prescription Program (TPP) on initiation of post-hospitalization BZD prescribing, both overall and among cardiac and cancer patients in the United States.
  
  
  METHODS
  Interrupted time-series of post-hospitalization BZD dispensing events to enrollees in the US Medicaid program in the states of New York (intervention group) and New Jersey (control group), before and after implementation of a TPP.
  
  
  METHODS
  Community-dwelling Medicaid enrollees in New York State (n = 67 962) and New Jersey (n = 71 701), hospitalized between 1 January 1988 and 30 November 1990.
  
  
  METHODS
  The New York State TPP, implemented on 1 January 1989, requires physicians to prescribe BZD on triplicate prescription forms for state surveillance.
  
  
  METHODS
  Rates and duration of new post-hospitalization use of BZD and substitute medications.
  
  
  RESULTS
  Overall, a sudden and sustained 63.5% decrease [95% confidence interval (CI) -58.6% to -68.3%] in new post-hospitalization BZD dispensing-from a baseline rate of 44 discharges with BZD dispensing per 1000 discharges per month-followed the TPP in New York State, without discontinuity in the control state. Patients hospitalized for acute ischemic cardiac events experienced a 72.5% reduction (95% CI -55.5% to -89.4%), and cancer patients a 69.4% reduction (95% CI -36.7% to -100.0%). The TPP did not preferentially reduce BZD use lasting >2 months. Increased substitute use did not offset reductions in BZD use.
  
  
  CONCLUSIONS
  By decreasing new short-term post-hospitalization BZD use, the New York State TPP also had unintended effects.
authors.affiliation: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, USA. anita_wagner@hms.harvard.edu
authors.forename: Anita K
authors.initials: AK
authors.lastname: Wagner
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Soumerai
authors.forename: Fang
authors.initials: F
authors.lastname: Zhang
authors.forename: Connie
authors.initials: C
authors.lastname: Mah
authors.forename: Linda
authors.initials: L
authors.lastname: Simoni-Wastila
authors.forename: Leon
authors.initials: L
authors.lastname: Cosler
authors.forename: Thomas
authors.initials: T
authors.lastname: Fanning
authors.forename: Peter
authors.initials: P
authors.lastname: Gallagher
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
mesh_terms: D000328:Adult; D000359:Aftercare / Q000191:economics / Q000639:trends*; D000368:Aged; D001569:Benzodiazepines / Q000191:economics / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000191:economics / Q000706:statistics & numerical data; D017723:Drug Utilization Review / Q000706:statistics & numerical data*; D005260:Female; D006331:Heart Diseases / Q000188:drug therapy / Q000523:psychology; D006801:Humans; D007356:Insurance, Pharmaceutical Services; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000523:psychology; D009515:New Jersey; D009518:New York; D010351:Patient Discharge / Q000639:trends*; D011159:Population Surveillance; D013221:State Health Plans; D014481:United States
chemical_list: D001569:Benzodiazepines