Does hospitalisation affect hypnotic and anxiolytic drug prescribing?

Objective: The aim of this study was to measure the impact of hospitalisation on hypnotic and anxiolytic (HA) drug prescription, during and after hospitalisation.

Method: A descriptive study was carried out over three periods: before, during and after hospitalisation (three-month follow-up), examining the presence or absence of HA treatment at each stage. The HA drug list studied was selected using the World Health Organisation (WHO) Anatomical Therapeutic and Chemical (ATC) classification system. Trained final-year pharmacy students asked a series of structured questions during hospitalisation and postal questionnaires were sent to included patients one and three months after discharge. All the in-patient departments in the University Hospital of Besançon-France-were included, except units with pre-, peri-, and post-operative HA treatments. All in-patients present in the selected units on February 12, 2003, aged over 18, who gave their consent and were considered able to answer by the nursing team, were finally included.

Main Outcome Measure: An eight-branch descriptive model, including the three study periods with two states (presence or absence of HA treatment) at each stage.

Results: A total of 260 in-patients were included, and a further 112 (43%) completed the whole study (alive, non re-hospitalised, one- and three- months post discharge response). 48% (n = 260), 64% (n = 260) and 58% (n = 112) of the included patients had sleep disorder complaints respectively before, during and after hospitalisation. HA usage increased when comparing pre- and during hospitalisation (33% vs. 51%; n = 112; p < 0.0001) and decreased when comparing during hospitalisation and post-discharge (51% vs. 43%; n = 112; p < 0.0001). The descriptive model showed an overall persistence of treatment induced by hospital stay in 5.35% of the patients.

Conclusion: Hospital appeared to have a significant impact on delayed HA use in the French general population. Our results should incite hospital prescribers to transversally reconsider the whole sleep disorder treatment strategy in hospital settings, from improving patient's accommodation conditions, to working out a consensus on the justification of prescription of HA and precising the exact place of nursing team in sleep disorders management.