Sleep medicines are often prescribed for older adults (≥75 years) without appropriate dosing instructions: A nationwide retrospective register study in Finland

IF 5.3 2区医学 Q1 PSYCHIATRY Acta Psychiatrica Scandinavica Pub Date : 2024-01-24 DOI:10.1111/acps.13661

Sini-Tuulia Eronen, Terhi Kurko, Sirkka-Liisa Kivelä, Tiina Paunio, Marja Airaksinen, Tomi Rantamäki

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Abstract

Background

Sleep medicines should be prescribed cautiously, accompanied by instructions that ensure appropriate use and reduce risks. This is especially important for older adults, for whom many of these medicines are classified as potentially inappropriate medicines.

Methods

We investigated the use and appropriateness of dosing instructions for sleep medicines (described in the Finnish National Current Care Guideline for Insomnia) prescribed for older adults (≥75 years) and dispensed with instruction label in pharmacies. The retrospective reimbursement register data for year 2020 by the Social Insurance Institution of Finland was used as the data source (1,080,843 purchases by 143,886 individuals of which 565,228 purchases were pharmacy dispenses). The appropriateness of the pharmacy dosing instructions containing keyword(s) referring to insomnia treatment was examined according to the prescribed dose, time of intake, frequency of use, and warnings/remarks. A random sample of 1000 instructions was used to manually analyze the phrasing and appropriateness.

Outcomes

We focused our analysis on 58.1% (328,285 purchases by 87,396 individuals) of the pharmacy dispenses, which contained dosing instructions referring insomnia treatment. Of these, zopiclone and mirtazapine were the most prescribed drugs (134,631 and 112,463 purchases, respectively). Dose and time of intake were specified in most of the instructions (98.4% and 83.4%, respectively), whereas frequency of use was specified in 57.3%. A small percentage of the instructions included warnings/remarks (2.8%). Overall, only 2.1% of the instructions contained information about a single dose, time of intake, temporary use, and warnings/remarks and were thus defined as sufficient. Notably, 47.7% (n = 515,615) of all the purchases in our dataset were dispensed via automated multi-dose dispensing systems, which is aimed for long-term treatment.

Interpretation

It is common to prescribe sleep medicines for older adults without appropriate dosing instructions, particularly excluding warnings against long-term, regular use. Actions to change the current prescribing practices are warranted.

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老年人（≥75 岁）经常在没有适当剂量说明的情况下服用睡眠药物：芬兰全国范围内的回顾性登记研究。

背景：应谨慎开具睡眠药物处方，并附有使用说明，以确保合理使用并降低风险。这一点对老年人尤为重要，因为对他们来说，许多此类药物都被归类为潜在的不适当药物：我们调查了药房为老年人（≥75 岁）处方并附有说明书标签的睡眠药物（在《芬兰国家失眠症现行护理指南》中有所描述）的使用情况和剂量说明的适当性。数据来源是芬兰社会保险机构 2020 年的回顾性报销登记数据（143886 人购买了 1,080,843 次药品，其中 565,228 次为药房配药）。根据处方剂量、服用时间、使用频率和警告/备注，对包含失眠治疗关键词的药房配药说明的适当性进行了研究。我们随机抽取了 1000 份说明书，对其措辞和适当性进行了人工分析：我们重点分析了 58.1%（87396 人购买 328285 次）的药房配药，这些配药包含失眠治疗的剂量说明。其中，佐匹克隆和米氮平是处方量最大的药物（分别为 134,631 次和 112,463 次）。大部分说明书（分别为 98.4%和 83.4%）都说明了服用剂量和时间，57.3%的说明书说明了使用频率。小部分说明书包含警告/备注（2.8%）。总体而言，只有 2.1%的说明书包含单次剂量、服用时间、临时使用和警告/备注等信息，因此被定义为足够。值得注意的是，在我们的数据集中，47.7%（n=515,615）的购买者是通过自动多剂量配药系统配药的，而这种配药系统是针对长期治疗的：为老年人开具睡眠药物处方时，没有适当的剂量说明，特别是不包括禁止长期、定期使用的警告，是很常见的现象。有必要采取行动改变目前的处方做法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Psychiatrica Scandinavica 医学-精神病学

CiteScore

11.20

自引率

3.00%

发文量

135

审稿时长

6-12 weeks

期刊介绍： Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers. Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.