PREDICTORS OF CHRONIC BENZODIAZEPINE USE IN A HEALTH MAINTENANCE ORGANIZATION SAMPLE

While expert recommendations caution against long-term benzodiazepine use in the elderly, survey data suggest increasing benzodiazepine use with age. Computerized pharmacy records of staff-model HMO were used t o examine benzodiazepine prescribing. Six-month prevalence of benzodia zepine use (2.8%) and prevalence of continued use (0.7%) were lower th an earlier reports. Prevalence was higher in women and increased stead ily with age. Among 7012 patients beginning benzodiazepine treatment, duration of use increased with patient age, prescription by a psychiat rist (vs. primary care or medical/surgical specialist), use of higher- potency drugs (lorazepam, and alprazolem, clonazepam) and larger numbe r of pills in the initial prescription. Individual physicians varied s ignificantly in drug choice, initial prescription size, and likelihood of chronic use. Among 200 patients treated in primary care, the physi cian-recorded indication for prescription was anxiety or depression in 27%, insomnia in 20%, and pain symptoms in 38%. These findings indica te a gap between benzodiazepine efficacy research and current clinical practice.