Hospice agencies in the United States vary widely in their use of benzodiazepines and antipsychotics, according to a new study. The findings reveal the need for standardized prescribing practices regarding these drugs, investigators say.
Benzodiazepines and antipsychotics are routinely prescribed for symptom management in hospice. But there is little high-quality evidence to guide their use, Lauren B. Gerlach, DO, and colleagues wrote in a new study published Monday in the Journal of the American Geriatrics Society. This lack of information likely explains the wide range of prescribing practices, she and her colleagues said.
The analysis included 1.4 million hospice-enrolled Medicare beneficiaries aged 65 years and older in 2017, representing over 4,200 hospice agencies. The researchers examined the agency-level rate of enrollees with benzodiazepine and antipsychotic prescription fills. They also compared agencies with the highest and lowest prescription rates across patient and agency characteristics, such as profit status, size and region.
The highest-prescribing hospice agencies had a smaller proportion of patients from minority populations. For-profit and larger hospices were much more likely to be in the highest prescribing group, although there were key differences by region. For example, a larger share of rural beneficiaries were in the highest benzodiazepine-prescribing group.
Patients’ clinical needs
These variations did not change with the characteristics of the hospice patients, suggesting that prescribing is influenced by factors other than the patients’ clinical needs, noted Gerlach, of the University of Michigan.
There appears to be significant variation in what is considered clinically appropriate use in the U.S. hospice population, she and her colleagues concluded.
Agency-level characteristics “may be important elements to help develop and focus interventions to promote appropriate prescribing,” Gerlach wrote. “Finally, it will be critical to explore the extent to which individual clinicians may contribute to this variation.”
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