Prescriptions of Benzodiazepines at a Japanese Hospital : Prescription-based Data Analysis at Teikyo University Hospital Using a Computer-ordering System

Nakao Mutsuhiro, Nomura Kyoko, Takeuchi Takeaki, Yamaji Kiyohisa, Yano Eiji

doi:10.15064/jjpm.46.12_1037

Objectives: Excessive benzodiazepine (BZP) use is a great issue from both clinical and public-health perspectives. Although Japan is the world's leading country for the number of benzodiazepine (BZP) prescriptions, no hospital-based report has documented this phenomenon exactly. Thus the purpose of this study was to evaluate the frequency of BZP prescriptions in comparison to selective serotonin reuptake inhibitors (SSRI) and serotonin and noradrenaline reuptake inhibitors (SNRI) in a single Japanese hospital throughout a year. Subjects: Annual BZP prescriptions were assessed with anti-depressants including SSRI and SNRI by using an electronic database of medical records for outpatients in a Japanese university hospital, which is a tertiary care hospital affiliated with a private university with approximately 600,000 visits of outpatients annually. Method: The analysis was separately performed according to the department groups (i.e. internal medicine, surgery, neurology, psychiatry and others). Diagnostic information was not obtained in the present study. For the possible indicator of excessive BZP prescriptions, a B/S ratio was defined as the ratio of the number of anxiolytic BZP prescribed (excluding hypnotic BZP) relative to SSRI and SNRI prescriptions. Results: Among the 644,444 hospital prescriptions, 11.9% were for BZP, 1.6% for SSRI/SNRI, and 2.3% for other anti-depressants. Of the BZP prescriptions, 26.8% were written by the internal medicine group. The B/S ratio was the highest in the department group of internal medicine (ratio=13.0), followed by the surgery (7.6), neurology (4.8), and psychiatry (2.5) groups. When the psychiatry group was regarded as reference, the tendency of prescriptions of anxiolytic BZP rather than SSRI or SNRI was statistically significant in the remaining four department groups, after controlling for the effects of patients' age and sex by a multiple logistic regression analysis. Conclusions: BZP prescriptions in the Japanese hospital were far more prevalent than prescriptions for SSRI and SNRI, especially in the internal medicine group. Pharmacological treatment should be carefully considered using evidence-based clinical guidelines; alternatively, physicians might refer patients to psychiatrists or specialists in mental health. The results of this study suggest that a good strategy to prevent the excessive prescription of BZP in Japan would be to distribute medical knowledge about the use of SSRI and SNRI to internists and primary care physicians. And researchers could play a significant role in such types of prescriptions by alerting physicians to appropriate use of BZP and SSRI/SNRI. This suggestion is supported by the present findings of the internal medicine group's share of BZP prescriptions in the hospital. Future studies are needed to precisely determine the causes of frequent BZP prescriptions in Japanese hospitals.

Prescriptions of Benzodiazepines at a Japanese Hospital : Prescription-based Data Analysis at Teikyo University Hospital Using a Computer-ordering System

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