New and Persistent Sedative Prescriptions Among Older Adults Following a Critical Illness: A Population-Based Cohort Study

Lisa D. Burry; Chaim M. Bell; Andrea Hill; Ruxandra Pinto; Damon C. Scales; Susan E. Bronskill; David Williamson; Louise Rose; Longdi Fu; Robert Fowler; Claudio M. Martin; Lisa Dolovich; Hannah Wunsch

doi:10.1016/j.chest.2022.12.033

New and Persistent Sedative Prescriptions Among Older Adults Following a Critical Illness: A Population-Based Cohort Study

Lisa D. Burry, Chaim M. Bell, Andrea Hill, Ruxandra Pinto, Damon C. Scales, Susan E. Bronskill, David Williamson, Louise Rose, Longdi Fu, Robert Fowler, Claudio M. Martin, Lisa Dolovich, Hannah Wunsch

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Abstract

Background: ICU survivors often have complex care needs and can experience insufficient medication reconciliation and polypharmacy. It is unknown which ICU survivors are at risk of new sedative use posthospitalization. Research Question: For sedative-naive, older adult ICU survivors, how common is receipt of new and persistent sedative prescriptions, and what factors are associated with receipt? Study Design and Methods: This population-based cohort study included ICU survivors aged ≥ 66 years who had not filled sedative prescriptions within ≤ 6 months before hospitalization (sedative-naive) in Ontario, Canada (2003-2019). Using multilevel logistic regression, demographic, clinical, and hospital characteristics and their association with new sedative prescription within ≤ 7 days of discharge are described. Variation between hospitals was quantified by using the adjusted median OR. Factors associated with persistent prescriptions (≤ 6 months) were examined with a multivariable proportional hazards model. Results: A total of 250,428 patients were included (mean age, 76 years; 61% male). A total of 15,277 (6.1%) filled a new sedative prescription, with variation noted across hospitals (2% [95% CI, 1-3] to 44% [95% CI, 3-57]); 8,458 (3.4%) filled persistent sedative prescriptions. Adjusted factors associated with a new sedative included: discharge to long-term care facility (adjusted OR [aOR], 4.00; 95% CI, 3.72-4.31), receipt of inpatient geriatric (aOR, 1.95; 95% CI, 1.80-2.10) or psychiatry (aOR, 2.76; 95% CI, 2.62-2.91) consultation, invasive ventilation (aOR, 1.59; 95% CI, 1.53-1.66), and ICU length of stay ≥ 7 days (aOR, 1.50; 95% CI, 1.42-1.58). The residual heterogeneity between hospitals (adjusted median OR, 1.43; 95% CI, 1.35-1.49) had a stronger association with new sedative prescriptions than the Charlson Comorbidity Index score or sepsis. Factors associated with persistent sedative use were similar with the addition of female subjects (subdistribution hazard ratio, 1.07; 95% CI, 1.02-1.13) and pre-existing polypharmacy (subdistribution hazard ratio, 0.88; 95% CI, 0.80-0.93). Interpretation: One in 15 sedative-naive, older adult ICU survivors filled a new sedative within ≤ 7 days of discharge; more than one-half of these survivors filled persistent prescriptions. New prescriptions at discharge varied widely across hospitals and represent the potential value of modifying prescription practices, including medication review and reconciliation.

Original language	English
Pages (from-to)	1425-1436
Number of pages	12
Journal	Chest
Volume	163
Issue number	6
Early online date	4 Jan 2023
DOIs	https://doi.org/10.1016/j.chest.2022.12.033
Publication status	Published - Jun 2023

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New and Persistent Sedative_BURRY_2023_GREEN AAMAccepted author manuscript, 336 KB

https://linkinghub.elsevier.com/retrieve/pii/S0012369223000119

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Burry, L. D., Bell, C. M., Hill, A., Pinto, R., Scales, D. C., Bronskill, S. E., Williamson, D., Rose, L., Fu, L., Fowler, R., Martin, C. M., Dolovich, L., & Wunsch, H. (2023). New and Persistent Sedative Prescriptions Among Older Adults Following a Critical Illness: A Population-Based Cohort Study. Chest, 163(6), 1425-1436. https://doi.org/10.1016/j.chest.2022.12.033

@article{3351931101bb4ccc8145bdc0559122c7,

title = "New and Persistent Sedative Prescriptions Among Older Adults Following a Critical Illness: A Population-Based Cohort Study",

abstract = "Background: ICU survivors often have complex care needs and can experience insufficient medication reconciliation and polypharmacy. It is unknown which ICU survivors are at risk of new sedative use posthospitalization. Research Question: For sedative-naive, older adult ICU survivors, how common is receipt of new and persistent sedative prescriptions, and what factors are associated with receipt? Study Design and Methods: This population-based cohort study included ICU survivors aged ≥ 66 years who had not filled sedative prescriptions within ≤ 6 months before hospitalization (sedative-naive) in Ontario, Canada (2003-2019). Using multilevel logistic regression, demographic, clinical, and hospital characteristics and their association with new sedative prescription within ≤ 7 days of discharge are described. Variation between hospitals was quantified by using the adjusted median OR. Factors associated with persistent prescriptions (≤ 6 months) were examined with a multivariable proportional hazards model. Results: A total of 250,428 patients were included (mean age, 76 years; 61% male). A total of 15,277 (6.1%) filled a new sedative prescription, with variation noted across hospitals (2% [95% CI, 1-3] to 44% [95% CI, 3-57]); 8,458 (3.4%) filled persistent sedative prescriptions. Adjusted factors associated with a new sedative included: discharge to long-term care facility (adjusted OR [aOR], 4.00; 95% CI, 3.72-4.31), receipt of inpatient geriatric (aOR, 1.95; 95% CI, 1.80-2.10) or psychiatry (aOR, 2.76; 95% CI, 2.62-2.91) consultation, invasive ventilation (aOR, 1.59; 95% CI, 1.53-1.66), and ICU length of stay ≥ 7 days (aOR, 1.50; 95% CI, 1.42-1.58). The residual heterogeneity between hospitals (adjusted median OR, 1.43; 95% CI, 1.35-1.49) had a stronger association with new sedative prescriptions than the Charlson Comorbidity Index score or sepsis. Factors associated with persistent sedative use were similar with the addition of female subjects (subdistribution hazard ratio, 1.07; 95% CI, 1.02-1.13) and pre-existing polypharmacy (subdistribution hazard ratio, 0.88; 95% CI, 0.80-0.93). Interpretation: One in 15 sedative-naive, older adult ICU survivors filled a new sedative within ≤ 7 days of discharge; more than one-half of these survivors filled persistent prescriptions. New prescriptions at discharge varied widely across hospitals and represent the potential value of modifying prescription practices, including medication review and reconciliation.",

author = "Burry, {Lisa D.} and Bell, {Chaim M.} and Andrea Hill and Ruxandra Pinto and Scales, {Damon C.} and Bronskill, {Susan E.} and David Williamson and Louise Rose and Longdi Fu and Robert Fowler and Martin, {Claudio M.} and Lisa Dolovich and Hannah Wunsch",

note = "Funding Information: This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). Funding was also provided by the Canadian Institutes of Health Research (Grant No. 159696). Funding Information: Author contributions: L. D. B. drafted the manuscript and is guarantor. L. D. B. and L. F. had full access to all the data in the study and take responsibility for the integrity of the data. L. D. B. A. H. and R. P. take responsibility for the accuracy of the data analyses. L. D. B. R. P. H. W. C. M. B. S. E. B. and D. C. S. contributed to the statistical plan. All authors contributed to study conception and design and data interpretation. All authors read and approved the final version. Role of sponsors: The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. Other contributions: The authors thank IQVIA Solutions Canada Inc. for use of their Drug Information File. Additional information: The e-Figures and e-Tables are available online under “ Supplementary Data.” Publisher Copyright: {\textcopyright} 2023 American College of Chest Physicians",

year = "2023",

month = jun,

doi = "10.1016/j.chest.2022.12.033",

language = "English",

volume = "163",

pages = "1425--1436",

journal = "Chest",

issn = "0012-3692",

publisher = "American College of Chest Physicians",

number = "6",

}

TY - JOUR

T1 - New and Persistent Sedative Prescriptions Among Older Adults Following a Critical Illness

T2 - A Population-Based Cohort Study

AU - Burry, Lisa D.

AU - Bell, Chaim M.

AU - Hill, Andrea

AU - Pinto, Ruxandra

AU - Scales, Damon C.

AU - Bronskill, Susan E.

AU - Williamson, David

AU - Rose, Louise

AU - Fu, Longdi

AU - Fowler, Robert

AU - Martin, Claudio M.

AU - Dolovich, Lisa

AU - Wunsch, Hannah

N1 - Funding Information: This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). Funding was also provided by the Canadian Institutes of Health Research (Grant No. 159696). Funding Information: Author contributions: L. D. B. drafted the manuscript and is guarantor. L. D. B. and L. F. had full access to all the data in the study and take responsibility for the integrity of the data. L. D. B. A. H. and R. P. take responsibility for the accuracy of the data analyses. L. D. B. R. P. H. W. C. M. B. S. E. B. and D. C. S. contributed to the statistical plan. All authors contributed to study conception and design and data interpretation. All authors read and approved the final version. Role of sponsors: The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. Other contributions: The authors thank IQVIA Solutions Canada Inc. for use of their Drug Information File. Additional information: The e-Figures and e-Tables are available online under “ Supplementary Data.” Publisher Copyright: © 2023 American College of Chest Physicians

PY - 2023/6

Y1 - 2023/6

N2 - Background: ICU survivors often have complex care needs and can experience insufficient medication reconciliation and polypharmacy. It is unknown which ICU survivors are at risk of new sedative use posthospitalization. Research Question: For sedative-naive, older adult ICU survivors, how common is receipt of new and persistent sedative prescriptions, and what factors are associated with receipt? Study Design and Methods: This population-based cohort study included ICU survivors aged ≥ 66 years who had not filled sedative prescriptions within ≤ 6 months before hospitalization (sedative-naive) in Ontario, Canada (2003-2019). Using multilevel logistic regression, demographic, clinical, and hospital characteristics and their association with new sedative prescription within ≤ 7 days of discharge are described. Variation between hospitals was quantified by using the adjusted median OR. Factors associated with persistent prescriptions (≤ 6 months) were examined with a multivariable proportional hazards model. Results: A total of 250,428 patients were included (mean age, 76 years; 61% male). A total of 15,277 (6.1%) filled a new sedative prescription, with variation noted across hospitals (2% [95% CI, 1-3] to 44% [95% CI, 3-57]); 8,458 (3.4%) filled persistent sedative prescriptions. Adjusted factors associated with a new sedative included: discharge to long-term care facility (adjusted OR [aOR], 4.00; 95% CI, 3.72-4.31), receipt of inpatient geriatric (aOR, 1.95; 95% CI, 1.80-2.10) or psychiatry (aOR, 2.76; 95% CI, 2.62-2.91) consultation, invasive ventilation (aOR, 1.59; 95% CI, 1.53-1.66), and ICU length of stay ≥ 7 days (aOR, 1.50; 95% CI, 1.42-1.58). The residual heterogeneity between hospitals (adjusted median OR, 1.43; 95% CI, 1.35-1.49) had a stronger association with new sedative prescriptions than the Charlson Comorbidity Index score or sepsis. Factors associated with persistent sedative use were similar with the addition of female subjects (subdistribution hazard ratio, 1.07; 95% CI, 1.02-1.13) and pre-existing polypharmacy (subdistribution hazard ratio, 0.88; 95% CI, 0.80-0.93). Interpretation: One in 15 sedative-naive, older adult ICU survivors filled a new sedative within ≤ 7 days of discharge; more than one-half of these survivors filled persistent prescriptions. New prescriptions at discharge varied widely across hospitals and represent the potential value of modifying prescription practices, including medication review and reconciliation.

AB - Background: ICU survivors often have complex care needs and can experience insufficient medication reconciliation and polypharmacy. It is unknown which ICU survivors are at risk of new sedative use posthospitalization. Research Question: For sedative-naive, older adult ICU survivors, how common is receipt of new and persistent sedative prescriptions, and what factors are associated with receipt? Study Design and Methods: This population-based cohort study included ICU survivors aged ≥ 66 years who had not filled sedative prescriptions within ≤ 6 months before hospitalization (sedative-naive) in Ontario, Canada (2003-2019). Using multilevel logistic regression, demographic, clinical, and hospital characteristics and their association with new sedative prescription within ≤ 7 days of discharge are described. Variation between hospitals was quantified by using the adjusted median OR. Factors associated with persistent prescriptions (≤ 6 months) were examined with a multivariable proportional hazards model. Results: A total of 250,428 patients were included (mean age, 76 years; 61% male). A total of 15,277 (6.1%) filled a new sedative prescription, with variation noted across hospitals (2% [95% CI, 1-3] to 44% [95% CI, 3-57]); 8,458 (3.4%) filled persistent sedative prescriptions. Adjusted factors associated with a new sedative included: discharge to long-term care facility (adjusted OR [aOR], 4.00; 95% CI, 3.72-4.31), receipt of inpatient geriatric (aOR, 1.95; 95% CI, 1.80-2.10) or psychiatry (aOR, 2.76; 95% CI, 2.62-2.91) consultation, invasive ventilation (aOR, 1.59; 95% CI, 1.53-1.66), and ICU length of stay ≥ 7 days (aOR, 1.50; 95% CI, 1.42-1.58). The residual heterogeneity between hospitals (adjusted median OR, 1.43; 95% CI, 1.35-1.49) had a stronger association with new sedative prescriptions than the Charlson Comorbidity Index score or sepsis. Factors associated with persistent sedative use were similar with the addition of female subjects (subdistribution hazard ratio, 1.07; 95% CI, 1.02-1.13) and pre-existing polypharmacy (subdistribution hazard ratio, 0.88; 95% CI, 0.80-0.93). Interpretation: One in 15 sedative-naive, older adult ICU survivors filled a new sedative within ≤ 7 days of discharge; more than one-half of these survivors filled persistent prescriptions. New prescriptions at discharge varied widely across hospitals and represent the potential value of modifying prescription practices, including medication review and reconciliation.

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U2 - 10.1016/j.chest.2022.12.033

DO - 10.1016/j.chest.2022.12.033

M3 - Article

SN - 0012-3692

VL - 163

SP - 1425

EP - 1436

JO - Chest

JF - Chest

IS - 6

ER -

New and Persistent Sedative Prescriptions Among Older Adults Following a Critical Illness: A Population-Based Cohort Study

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