title: Effects of a geriatric intervention aiming to improve quality care in nursing homes on benzodiazepine use and discontinuation.
abstract: BACKGROUND
  Benzodiazepines and "Z drugs" are often prescribed in residents of nursing homes (NH) despite their well-known deleterious effects. We aimed to investigate if a general intervention on quality of care led to discontinuation of benzodiazepine, and to examine which NH-related factors were associated in change of benzodiazepines use.
  
  
  METHODS
  IQUARE is a quasi-experimental study, investigating the impact of an intervention based on a geriatric education with NH staff on several quality indicators of care (including appropriate prescriptions). All participating NH received an initial and 18-month audit regarding drug prescriptions and other quality of care variables. The analysis included 3973 residents, 2151 subjects (mean age: 84.6 ± 8.5 years; 74.3% women) in the control group and 1822 (mean age: 85.5 ± 8.1 years; 77.4% women) in the intervention group. Outcomes at 18 months were benzodiazepines use, long-acting benzodiazepines use, new-use of benzodiazepines, and discontinuation. The effect of the intervention was investigated using mixed-effect logistic regression models, including NH variables and residents' health status as confounders.
  
  
  RESULTS
  Higher reductions in benzodiazepine use (-2.8% vs. -1.5%) and long-acting benzodiazepine (-3.7% vs. -3.5%) were observed in intervention group, but not statistically significant. None of the structural and organisational NH-related variables predicted either discontinuation or new-use of benzodiazepines; hospitalisations and initial use of meprobamate increased the likelihood of becoming a new-user of benzodiazepines. Multivariate analysis suggested that living in a particular NH could affect benzodiazepines discontinuation.
  
  
  CONCLUSIONS
  A general intervention designed to improve overall NH quality indicators did not succeed in reducing benzodiazepines use. External factors interfered with the intervention. Further studies are needed to examine which NH-related aspects could impact benzodiazepines discontinuation.
authors.affiliation: Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse.|UMR7268 Aix-Marseille Univ., Laboratoire d'Anthropologie bioculturelle, droit, éthique et santé
authors.forename: Philipe
authors.initials: P
authors.lastname: de Souto Barreto
authors.affiliation: UMR INSERM 1027, University of Toulouse III, Toulouse.|Service de Pharmacologie Médicale et Clinique, CIC Inserm 1436, CHU de Toulouse, 37 Allees Jules Guesde, F-31000, Toulouse.
authors.forename: Maryse
authors.initials: M
authors.lastname: Lapeyre-Mestre
authors.affiliation: UMR INSERM 1027, University of Toulouse III, Toulouse.|Pôle Pharmacie, CHU de Toulouse, 1 avenue Jean Poulhès, F 31059, Toulouse, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Cestac
authors.affiliation: Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse.|UMR INSERM 1027, University of Toulouse III, Toulouse.
authors.forename: Bruno
authors.initials: B
authors.lastname: Vellas
authors.affiliation: Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse.|UMR INSERM 1027, University of Toulouse III, Toulouse.
authors.forename: Yves
authors.initials: Y
authors.lastname: Rolland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000592:standards* / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006299:Health Services for the Aged / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008297:Male; D009735:Nursing Homes / Q000592:standards*; D019338:Polypharmacy; D058996:Quality Improvement; D019984:Quality Indicators, Health Care / Q000639:trends*; D011795:Surveys and Questionnaires
chemical_list: D001569:Benzodiazepines
keywords: benzodiazepine; elderly; meprobamate; nursing home; zolpidem; zopiclone