Center Predictors of Long-Term Benzodiazepine Use in Chronic Obstructive Pulmonary Disease and Posttraumatic Stress Disorder.

RATIONALE: Symptoms of insomnia and anxiety are common among patients with chronic obstructive pulmonary disease (COPD)-especially among patients with comorbid mental health disorders such as posttraumatic stress disorder (PTSD). Benzodiazepines provide temporary relief of these symptoms, but guidelines discourage routine use of benzodiazepines due to the serious risks posed by these medications. A more thorough understanding of guideline discordant benzodiazepine use will be critical to reduce potentially inappropriate prescribing and its associated risks.

OBJECTIVE: Examine the national prevalence, variability, and center correlates of long-term benzodiazepine prescriptions for patients with COPD and comorbid PTSD.

METHODS: We identified patients with COPD and PTSD between 2010-2012 who received care within the VA. We used a mixed-effects logistic regression model to assess center predictors of long-term benzodiazepine prescriptions (≥90 days), while accounting for patient characteristics.

RESULTS: Of 43,979 patients diagnosed with COPD and PTSD at 129 centers, 24.4% were prescribed benzodiazepines long-term, with use varying from 9.5-49.4% by medical center. Patients with long-term prescriptions were more likely to be white (90.1 vs. 80.7%) and have other mental health comorbidities including generalized anxiety disorder (31.3 vs. 16.5%). Accounting for patient mix and characteristics, long-term benzodiazepine use was associated with lower patient-reported access to mental health care (OR 0.54, 95%CI 0.37-0.80).

CONCLUSIONS: Long-term benzodiazepine prescribing is common among patients at high risk for complications, although this practice varies substantially from center to center. Poor access to mental health care is a potential driver of this guideline inconsistent use.