A retrospective data analysis of the impact of the New York triplicate prescription program on benzodiazepine use in medicaid patients with chronic psychiatric and neurologic disorders

  • L. S
  • D. R
  • C. M
 et al. 
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Abstract

Background: Benzodiazepines are treatment mainstays for several disorders, but there is often concern about dependency and addiction. In January 1989, New York implemented regulations requiring physicians to order benzodiazepines using state-monitored triplicate prescription forms. Objective: The purpose of this study was to assess the effects of the triplicate prescription program (TPP) on changes in use of benzodiazepines and other psychoactive drugs in clinically vulnerable Medicaid populations. Methods: Using an interrupted time series with comparison series design, psychoactive medication use was examined in the New York (intervention) and New Jersey (control) Medicaid programs before and after implementation of the New York benzodiazepine TPP among community-dwelling Medicaid beneficiaries aged >19 years continuously enrolled from January 1988 through December 1990 in New York or New Jersey with diagnoses of schizophrenia, schizophreniform disorder, schizoaffective disorder, schizoid personality disorder, or schizotypal personality disorder; bipolar disorder; epilepsy; and/or panic disorder, agoraphobia without history of panic disorder, social phobia, or specific phobia. Results: A total of 125,837 New York and 139,405 New Jersey Medicaid beneficiaries were continuously enrolled and met the study inclusion criteria. Of these, there were 6054 Medicaid enrollees in New York and 6875 enrollees in New Jersey who were clinically vulnerable patients with >1 of the specified diagnoses. New York Medicaid patients with any of these diagnoses experienced a -48.1% relative change (95% CI, -50.0% to -46.2%) in benzodiazepine use at 6 months after TPP implementation, with no decline in use in New Jersey patients. The largest reduction in benzodiazepine use was seen among patients with seizure disorder (-59.9% at 6 months; 95% CI, -63.9% to -55.9%). Although use of substitute drugs increased slightly in New York after the TPP, it did not offset reductions in benzodiazepine use. The effects of TPP were sustained for 7 years of follow-up and had the greatest impact on nonproblematic benzodiazepine use. Conclusions: During the time period studied in this analysis, the New York TPP reduced benzodiazepine use among chronically ill patients for whom these agents represent effective treatment. Our findings suggest that many patients previously receiving benzodiazepines did not receive any pharmacologic intervention. Copyright © 2004 Excerpta Medica, Inc.

Author-supplied keywords

  • *United States
  • *benzodiazepine
  • *benzodiazepine/ct [Clinical Trial]
  • *benzodiazepine/dt [Drug Therapy]
  • *benzodiazepine/pd [Pharmacology]
  • *data analysis
  • *medicaid
  • *mental disease/di [Diagnosis]
  • *mental disease/dt [Drug Therapy]
  • *mental disease/ep [Epidemiology]
  • *mental health research
  • *neurologic disease
  • *neurologic disease/di [Diagnosis]
  • *neurologic disease/dt [Drug Therapy]
  • *neurologic disease/ep [Epidemiology]
  • *patient
  • *pharmaceutical care
  • *policy
  • *prescription
  • *vulnerable population
  • United States
  • addiction
  • adult
  • aged
  • agoraphobia
  • agoraphobia/di [Diagnosis]
  • agoraphobia/dt [Drug Therapy]
  • agoraphobia/ep [Epidemiology]
  • article
  • benzodiazepine derivative
  • bipolar disorder
  • bipolar disorder/di [Diagnosis]
  • bipolar disorder/dt [Drug Therapy]
  • bipolar disorder/ep [Epidemiology]
  • chronic patient
  • clinical trial
  • community
  • controlled clinical trial
  • controlled study
  • diagnosis
  • drug effect
  • drug therapy
  • epilepsy
  • epilepsy/di [Diagnosis]
  • epilepsy/dt [Drug Therapy]
  • epilepsy/ep [Epidemiology]
  • female
  • follow up
  • human
  • major clinical study
  • male
  • panic
  • panic/di [Diagnosis]
  • panic/dt [Drug Therapy]
  • panic/ep [Epidemiology]
  • phobia
  • physician
  • population
  • prescription
  • psychotropic agent
  • retrospective study
  • schizoaffective psychosis
  • schizoaffective psychosis/di [Diagnosis]
  • schizoaffective psychosis/dt [Drug Therapy]
  • schizoaffective psychosis/ep [Epidemiology]
  • schizoidism
  • schizoidism/di [Diagnosis]
  • schizoidism/dt [Drug Therapy]
  • schizoidism/ep [Epidemiology]
  • schizophrenia
  • schizophrenia/di [Diagnosis]
  • schizophrenia/dt [Drug Therapy]
  • schizophrenia/ep [Epidemiology]
  • schizophreniform disorder
  • schizophreniform disorder/di [Diagnosis]
  • schizophreniform disorder/dt [Drug Therapy]
  • schizophreniform disorder/ep [Epidemiology]
  • schizotypal personality disorder
  • schizotypal personality disorder/di [Diagnosis]
  • schizotypal personality disorder/dt [Drug Therapy]
  • schizotypal personality disorder/ep [Epidemiology]
  • seizure
  • seizure, epilepsy and convulsion/di [Diagnosis]
  • seizure, epilepsy and convulsion/dt [Drug Therapy]
  • seizure, epilepsy and convulsion/ep [Epidemiology]
  • social phobia
  • social phobia/di [Diagnosis]
  • social phobia/dt [Drug Therapy]
  • social phobia/ep [Epidemiology]
  • time series analysis

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Authors

  • Simoni-Wastila L.

  • Ross-Degnan D.

  • Mah C.

  • Gao X.

  • Brown J.

  • Cosler L.E.

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