A Population-Based Examination of Benzodiazepine Receptor Agonist & Z-drug Dispensations in the Alberta Population: Prevalence of Use and Indicators of Potentially Inappropriate Use and Prescribing
Bibliographic record
Abstract
IntroductionCanadian clinical practice guidelines for the management of anxiety disorders and insomnia suggest that benzodiazepine receptor agonist and Z-drug (BZRA) treatment is appropriate for short term use in adults (aged 20-64); use of BZRA’s outside of these recommendations is considered “potentially inappropriate” given the increased potential for adverse effects. Objectives and ApproachThe objective of this study was to characterize the use of BZRA’s for all individuals 10 years of age or older in the province of Alberta in 2015 and to explore indicators of potentially inappropriate prescribing and use. Using data from Alberta’s Pharmaceutical Information Network (PIN) as well as Vital Statistics, prevalence of BZRA use was determined as were characteristics of BZRA dispensations according to prescriber type, days supply and number of defined daily doses. Patient-level indicators of potentially inappropriate BZRA prescribing or use (days of consecutive use, use of multiple ingredients etc.) were calculated by age category and sex. ResultsOverall, 372,870 individuals received 2,463,585 BZRA dispensations in 2015 (10% of Alberta population). The majority of users were female (63%), 28% were 65 years of age or older and 20% of individuals were dispensed both z-drugs and benzodiazepines. BZRA users received a median of 3 dispensations (IQR: 1-6), for a total of 91 days (IQR: 30-261) of use in the year, with a median period of consecutive use around 51 days (IQR: 21-128). 26\% of individuals utilized these medications for 121 consecutive days or more increasing to 40% in those 65 + years of age. 17% of individuals utilized more than one distinct BZRA ingredient concurrently while those in the 20-49 year age group were most likely to visit multiple prescribers. Conclusion/ImplicationsPrevalence of BZRA use in Alberta is high, especially among females and the elderly. This study supports the need for patient and physician education, decision support for prescribers and continued monitoring of medication dispensing at the population level within the province of Alberta
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".