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

Jan 09, 2023

Experts: 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

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 post-hospitalization.
For sedative-naïve older adult ICU survivors, how common is receipt of new and persistent sedative prescriptions, and what factors are associated with receipt?
Population-based cohort study of ICU survivors ≥66 years who had not filled sedative prescriptions ≤6 months pre-hospitalization (sedative-naïve) in Ontario, Canada (2003 – 2019). Using multilevel logistic regression, we described demographic, clinical, and hospital characteristics and their association with new sedative prescription ≤7 days of discharge. We quantified variation between hospitals using the adjusted median odds ratio (aMOR). Factors associated with persistent prescriptions (≤6 months) were examined with multivariable proportional hazards model.
250,428 patients were included (mean age 76, 61% male). 15,277 (6.1%) filled a new sedative prescription with variation across hospitals (2% (95% CI 1-3) to 44% (3-57)); 8,458 (3.4%) filled persistent sedative prescriptions. Adjusted factors associated with a new sedative included: discharge to long-term care facility (aOR 4.00, 3.72-4.31); receipt of inpatient geriatric (aOR 1.95, 1.80-2.10) or psychiatry (aOR 2.76, 2.62-2.91) consultation, invasive ventilation (aOR 1.59, 1.53-1.66), and ICU length of stay ≥7 days (aOR 1.50, 1.42-1.58). The residual heterogeneity between hospitals (aMOR 1.43, 1.35-1.49) had a stronger association with new sedative prescriptions than Charlson comorbidity score or sepsis. Factors associated with persistent sedative use were similar with the addition of females (sHR 1.07, 1.02-1.13) and pre-existing polypharmacy (sHR 0.88, 0.80-0.93).
One in 15 sedative-naïve older adult ICU survivors filled a new sedative ≤7 days of discharge, of whom more than half 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.

Copyright © 2023. Published by Elsevier Inc.

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ABOUT THE EXPERTS

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

Lisa D Burry

Department of Pharmacy and Medicine, Sinai Health System; Leslie Dan Faculty of Pharmacy and Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada. Electronic address: lisa.burry@sinaihealth.ca.

Chaim M Bell

Department of Medicine, Sinai Health System; Departments of Medicine and Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.

Andrea Hill

Department of Critical Care Medicine, Sunnybrook Health Sciences Centre; Sunnybrook Research Institute, Toronto, ON, Canada.

Ruxandra Pinto

Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.

Damon C Scales

Department of Critical Care Medicine, Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care, University of Toronto; ICES, Toronto, ON, Canada.

Susan E Bronskill

Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto; Sunnybrook Research Institute, Toronto, ON, Canada.

David Williamson

Faculté de Pharmacie, Université de Montréal; Pharmacy department, Hôpital du Sacré-Cœur de Montréal; and Research center, CIUSSS du Nord-de-l’Île-de-Montréal, PQ, Canada.

Louise Rose

Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK.

Longdi Fu

ICES, Toronto, ON, Canada.

Robert Fowler

Department of Critical Care Medicine, Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care, University of Toronto; ICES, Toronto, ON, Canada.

Claudio M Martin

Division of Critical Care, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, and Lawson Health Research Institute, London, ON, Canada.

Lisa Dolovich

Leslie Dan Faculty of Pharmacy University of Toronto, Toronto, ON, Canada.

Hannah Wunsch

Department of Critical Care Medicine, Sunnybrook Health Sciences Centre; Department of Anesthesiology and Pain Medicine and Interdepartmental Division of Critical Care, University of Toronto; ICES, Toronto, ON, Canada.