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Journal of the American Geriatrics Society
01, 2021;69 (1): 98-105.

Benzodiazepine Use among Medicare, Commercially Insured, and Veteran Older Adults, 2013-2017.

Donovan T Maust, H Myra Kim, Ilse R Wiechers, Rosalinda V Ignacio, Amy S B Bohnert, Frederic C Blow
Author Information
  1. Donovan T Maust: Department of Psychiatry, University of Michigan, Ann Arbor, Michigan. ORCID
  2. H Myra Kim: Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
  3. Ilse R Wiechers: Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, West Haven, Connecticut.
  4. Rosalinda V Ignacio: Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.
  5. Amy S B Bohnert: Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
  6. Frederic C Blow: Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.
PMID: 32951209 DOI: 10.1111/jgs.16825

Abstract

BACKGROUND/OBJECTIVES: Benzodiazepines (BZDs) are widely prescribed to older adults. Although prescribing has declined in the U.S. Department of Veterans Affairs (VA), Medicare introduced BZD coverage in 2013. It is unknown whether declines in the VA have been widespread among older adults in the United States.
DESIGN: Observational study in traditional fee-for-service Medicare, commercial insurance, and the VA.
SETTING: United States, 2013-2017.
PARTICIPANTS: Adults aged 55 and older in traditional Medicare (234,290,693 person-months), commercial insurance (337,827,125 person-months), and the VA (256,590,369 person-months).
MEASUREMENTS: (1) Change in BZD and BZD-opioid co-prescribing modeled by Poisson regression over time; and (2) standardized ratios of BZD and BZD-opioid co-prescribing, using Medicare as the reference.
RESULTS: From April 2013 to December 2017, the monthly percentage of adults aged 55 and older who received BZDs fell from 10.4% to 9.3% in Medicare, 6.6% to 6.5% in commercial insurance, and 5.7% to 3.0% in the VA. Monthly BZD-opioid co-prescribing over the same time fell from 4.0% to 3.0% in Medicare, 2.3% to 2.0% in commercial, and 2.2% to .6% for the VA. Age- and sex-adjusted rates of decline for BZD and BZD-opioid co-prescribing were statistically significant for all systems. Annual BZD rate reductions were .98 (Medicare), .99 (commercial), and .87 (VA; P < .001 for all); co-prescribing rate reductions were .95, .99, and .75 (P < .001 for all). Using standardized ratios accounting for demographic and clinical characteristics, both prescribing and co-prescribing were lowest for the VA relative to Medicare (standardized BZD ratio = .40; 95% confidence interval [CI] = .39-.40; standardized BZD-opioid co-prescribing ratio = .35; 95% CI = .35-.35). Prescribing in commercial insurance was also lower (BZD = .65; 95% CI = .65-.65; BZD-opioid co-prescribing = .65; 95% CI = .65-.65).
CONCLUSION: BZD prescribing has declined much more to older adults receiving care through the VA than Medicare or commercial insurance. Other systems may learn from strategies implemented in the VA.

Keywords

Medicare benzodiazepine veteran

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Grants

  1. I01 HX002340/HSRD VA
  2. R01 DA045705/NIDA NIH HHS
  3. IIR 16-210/HSRD VA
  4. R01DA045705/NIDA NIH HHS

MeSH Term

Aged
Benzodiazepines
Fee-for-Service Plans
Female
Humans
Male
Medicare
Medicare Part C
Middle Aged
Practice Patterns, Physicians'
Retrospective Studies
United States
United States Department of Veterans Affairs
Veterans

Chemicals

Benzodiazepines
Journal Article Observational Study Research Support, N.I.H., Extramural Research Support, U.S. Gov't, Non-P.H.S.
Article has an altmetric score of 31

Word Cloud

Created with Highcharts 10.0.0MedicareVABZDco-prescribingcommercialBZD-opioidolderinsurance=adults2standardized0%95%65prescribingperson-monthsCI= BZDsdeclined2013amongUnitedStatestraditional2013-2017Adultsaged55timeratiosfell3%66%3systemsratereductions99P<001ratio403565-BACKGROUND/OBJECTIVES:BenzodiazepineswidelyprescribedAlthoughUSDepartmentVeteransAffairsintroducedcoverageunknownwhetherdeclineswidespreadDESIGN:Observationalstudyfee-for-serviceSETTING:PARTICIPANTS:234290693337827125256590369MEASUREMENTS:1ChangemodeledPoissonregressionusingreferenceRESULTS:AprilDecember2017monthlypercentagereceived104%95%57%Monthly42%Age-sex-adjustedratesdeclinestatisticallysignificantAnnual98879575Usingaccountingdemographicclinicalcharacteristicslowestrelativeconfidenceinterval[CI]39-35-PrescribingalsolowerCONCLUSION:muchreceivingcaremaylearnstrategiesimplementedBenzodiazepineUseCommerciallyInsuredVeteranOlderbenzodiazepineveteran

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