Research award winners find new way to reduce overmedication

If you’ve ever spent the night in the hospital, you know it’s difficult to get any sleep. Between the sounds of machines, people checking in, and early-morning labs, it’s no wonder patients can’t sleep through the night.

Besides making it more difficult for patients to heal, lack of sleep in the hospital creates another adverse side effect – overprescription of sleep medications. When patients request sleep aids in the hospital, these medications are often continued after they are discharged, putting patients (especially elderly patients) at risk for falls, memory problems, and physical dependence on the drug.

“[Overprescription] is a vicious cycle”

“We’re very good at prescribing medications but stopping medications makes people nervous,” said Dr. Marnie Wilson, internal medicine resident at McGill University, “It’s a vicious cycle.”

Stopping the cycle

Researchers at the McGill University Health Centre (MUHC) wanted to find a way to reverse the pattern of patients leaving the hospitals with more Benzodiazepine prescriptions. In a previous study, they mailed an educational brochure to patients about risks of these sleep medications, and more than a quarter of them subsequently discontinued their prescriptions.

“We thought, what would happen if we gave the same brochure to patients in the hospital, and could discuss the issue with them,” said Dr. Wilson, the lead author of the study abstract.

67% of patients discontinued their sleep medication while in the hospital

The results were even better than the team expected. When they gave the brochure to patients over age 60 at the teaching unit of the McGill University Health Centre, 67% discontinued their sleep medication while in the hospital, and over half maintained discontinuation after 30 days out of the hospital. Patients did not report worse quality of sleep after stopping the medication.

The spillover effect

Another exciting result researchers did not expect was the effect on physician prescribing habits. The overall rate at which doctors prescribed Benzodiazepines at discharge declined from almost 70% to less than 25% over the course of the study. “Just having the brochures around and having patients talking to doctors created a change in prescribing practices,” said Dr. Wilson.

Dr. Wilson presented their research at the 2017 Lown Conference and won the Audience Award for Best Abstract in the Overuse Interventions category. The MUHC team hopes to expand this intervention throughout Canada, as well as pilot a new computer program that prompts doctors to deprescribe when appropriate.