Assessing the prescribing trends and patterns of oral benzodiazepines at outpatient pharmacy of Hospital Tengku Ampuan Afzan (HTAA), Kuantan, Pahang

Abstract

The vast use of benzodiazepines has been a prime cause for concern to healthcare professionals and policy makers around the world. Nevertheless, there is a paucity of literature concerning benzodiazepines prescribing practice in Malaysia. Thus, this study aimed to evaluate the prescribing trends and patterns of oral benzodiazepines at the outpatient pharmacy of Hospital Tengku Ampuan Afzan, Kuantan, Pahang and assess the association between patient demographic characteristics with the prescribing patterns. The study conducted retrospectively using data of prescriptions issued from January 2014 until December 2016. The data were assembled using a data collection form and transferred to STATA® software for cleaning, processing and analysis. The descriptive analysis was used to report the demographic characteristic of the patients, prescriber’s speciality, number of patients and prescriptions, as well as the type of benzodiazepine, duration of action, onset of action, dosing schedule, duration of supply, concurrent medications and diagnosis. Throughout the study period, we observed a drop of 12.6% number of prescriptions from 2014 (n=1956) to 2016 (n=1709). Likewise, the number of patients receiving benzodiazepines was also decreased by approximately 13% from 2014 (n=676) to 2016 (n=584). The defined daily dose (DDD/1000 patients/year) also showed a decreasing trend in which 1.9% and 7.25% decrease was observed in 2015 and 2016 respectively. Alprazolam, short-acting benzodiazepines and anxiolytics (N05BA) were the most frequently prescribed with 39.67%, 40.32% and 82.32% respectively. Approximately, 69.64% (n=6,218) of benzodiazepines prescribed were for a 15-30 days duration, while 57.28% (n=5,115) of benzodiazepines were prescribed with fixed dosing schedule rather than as per needed (PRN) dosing. Majority (81.53%, n=7,280) prescriptions generated were from the psychiatric and mental health department, and about 90.5% (n=8,081) of prescriptions were written with a diagnosis related to psychiatric disorders. Additionally, about 51.41% (n=2,945) prescriptions were issued for male patients, 56.77% (n=3,252) are among Malays and patient within the age band of 45-54 years old (29.42%, n=1,685) was the highest recipient. In general, there is a significant relationship seen between patient’s age group and gender with the prescribing patterns of benzodiazepines. All chi-square tested towards the patterns showed result lower than the decided significance levels (p=0.005). In conclusion, overall benzodiazepines prescribing trends in Malaysia was low throughout the three retrospective years compared to the increasing psychiatric problems in the country. Taking into account the downward trend of the benzodiazepines utilisation from 2011 to 2014 as identified in the Malaysian Statistics Of Medicines 2015, this study found that our results share corresponding trends with the nationwide consumption. Consequently, the DDD of benzodiazepines was found to be in declining trends and relatively low compared to other countries. As a whole, it is believed that this study provides sufficient data that could be a jump start for future work. The trends and patterns described in the study allow for an estimation of the prevalence of the medical condition, providing the basis of risk assessment and pharmacovigilance and also set a standard for future reference of trends and patterns of benzodiazepines in Malaysia.