Effect of New York State regulatory action on benzodiazepine prescribing and hip fracture rates.

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dc.contributor.authorWagner, Anita K.
dc.contributor.authorRoss-Degnan, Dennis
dc.contributor.authorGurwitz, Jerry H.
dc.contributor.authorZhang, Fang
dc.contributor.authorGilden, Daniel B.
dc.contributor.authorCosler, Leon
dc.contributor.authorSoumerai, Stephen B.
dc.contributor.departmentDepartment of Medicine, Division of Geriatric Medicine
dc.contributor.departmentMeyers Primary Care Institute
dc.date2022-08-11T08:09:23.000
dc.date.accessioned2022-08-23T16:28:54Z
dc.date.available2022-08-23T16:28:54Z
dc.date.issued2007-01-16
dc.date.submitted2009-09-25
dc.description.abstractBACKGROUND: Medicare Part D excludes benzodiazepines from coverage, and numerous state government policies limit use of benzodiazepines. No data indicate that such policies have decreased the incidence of hip fracture. OBJECTIVE: To assess whether a statewide policy that decreased the use of benzodiazepines among elderly persons by more than 50% has decreased the incidence of hip fracture. DESIGN: A quasi-experiment comparing changes in outcomes before and after a policy change in a study U.S. state (New York) and a control state (New Jersey). SETTING: Two U.S. state Medicaid programs, 1988-1990. PATIENTS: Medicaid enrollees in New York (n = 51 529) and New Jersey (n = 42 029) who received or did not receive a benzodiazepine. MEASUREMENTS: Benzodiazepine prescribing and hazard ratios for hip fracture, adjusted for age and eligibility category. INTERVENTION: A statewide policy, implemented in New York in 1989, that required triplicate forms for benzodiazepine prescribing to allow surveillance by health authorities. RESULTS: The triplicate prescription policy immediately resulted in a 60.3% (95% CI, -66.3% to -54.2%) reduction in benzodiazepine use among women and 58.5% (-64.3% to -52.8%) among men. Benzodiazepine use in New Jersey remained stable. Hazard ratios for hip fracture that were adjusted for age and eligibility category did not change in New York or New Jersey when the periods before and after use of the triplicate prescription policy were compared (change from 1.2 to 1.1 among female benzodiazepine recipients [P = 0.70], 1.3 to 1.1 [P = 0.08] among female nonrecipients, 0.8 to 1.1 [P = 0.56] among male recipients, and 1.1 to 1.3 [P = 0.46] among male nonrecipients). LIMITATIONS: Information was lacking on race, benzodiazepine dose, and other potential determinants of continued benzodiazepine prescribing. CONCLUSIONS: Policies that lead to substantial reductions in the use of benzodiazepines among elderly persons do not necessarily lead to decreased incidence of hip fracture. Limitations on coverage of benzodiazepines under Medicare Part D may not achieve this widely assumed clinical benefit.
dc.identifier.citationAnn Intern Med. 2007 Jan 16;146(2):96-103.
dc.identifier.contextkey1016874
dc.identifier.issn1539-3704
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/meyers_pp/50
dc.identifier.pmid17227933
dc.identifier.pmid17227933
dc.identifier.submissionpathmeyers_pp/50
dc.identifier.urihttps://hdl.handle.net/20.500.14038/37122
dc.language.isoen_US
dc.publisherAmerican College of Physicians--American Society of Internal Medicine
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=17227933&dopt=Abstract">Link to article in PubMed</a>
dc.relation.urlhttp://www.annals.org/cgi/content/full/146/2/96
dc.source.issue2
dc.source.journaltitleAnnals of internal medicine
dc.source.volume146
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectAnti-Anxiety Agents
dc.subjectBenzodiazepines
dc.subjectDrug Prescriptions
dc.subjectFemale
dc.subjectHip Fractures
dc.subjectHumans
dc.subjectIncidence
dc.subjectLegislation, Drug
dc.subjectLongitudinal Studies
dc.subjectMale
dc.subjectMedicaid
dc.subjectNew Jersey
dc.subjectNew York
dc.subjectHealth Services Research
dc.subjectMedicine and Health Sciences
dc.titleEffect of New York State regulatory action on benzodiazepine prescribing and hip fracture rates.
dc.typeJournal Article
dspace.entity.typePublication
html.description.abstract<p>BACKGROUND: Medicare Part D excludes benzodiazepines from coverage, and numerous state government policies limit use of benzodiazepines. No data indicate that such policies have decreased the incidence of hip fracture.</p> <p>OBJECTIVE: To assess whether a statewide policy that decreased the use of benzodiazepines among elderly persons by more than 50% has decreased the incidence of hip fracture.</p> <p>DESIGN: A quasi-experiment comparing changes in outcomes before and after a policy change in a study U.S. state (New York) and a control state (New Jersey).</p> <p>SETTING: Two U.S. state Medicaid programs, 1988-1990.</p> <p>PATIENTS: Medicaid enrollees in New York (n = 51 529) and New Jersey (n = 42 029) who received or did not receive a benzodiazepine.</p> <p>MEASUREMENTS: Benzodiazepine prescribing and hazard ratios for hip fracture, adjusted for age and eligibility category.</p> <p>INTERVENTION: A statewide policy, implemented in New York in 1989, that required triplicate forms for benzodiazepine prescribing to allow surveillance by health authorities.</p> <p>RESULTS: The triplicate prescription policy immediately resulted in a 60.3% (95% CI, -66.3% to -54.2%) reduction in benzodiazepine use among women and 58.5% (-64.3% to -52.8%) among men. Benzodiazepine use in New Jersey remained stable. Hazard ratios for hip fracture that were adjusted for age and eligibility category did not change in New York or New Jersey when the periods before and after use of the triplicate prescription policy were compared (change from 1.2 to 1.1 among female benzodiazepine recipients [P = 0.70], 1.3 to 1.1 [P = 0.08] among female nonrecipients, 0.8 to 1.1 [P = 0.56] among male recipients, and 1.1 to 1.3 [P = 0.46] among male nonrecipients).</p> <p>LIMITATIONS: Information was lacking on race, benzodiazepine dose, and other potential determinants of continued benzodiazepine prescribing.</p> <p>CONCLUSIONS: Policies that lead to substantial reductions in the use of benzodiazepines among elderly persons do not necessarily lead to decreased incidence of hip fracture. Limitations on coverage of benzodiazepines under Medicare Part D may not achieve this widely assumed clinical benefit.</p>
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