{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T13:50:36Z","timestamp":1747230636329,"version":"3.40.5"},"reference-count":27,"publisher":"SMW Supporting Association","issue":"11","license":[{"start":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T00:00:00Z","timestamp":1730419200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Swiss Med Wkly"],"abstract":"<jats:p>AIMS OF THE STUDY: Physicians frequently prescribe antipsychotics off-label to treat, among others, insomnia and anxiety. The Swiss \u201csmarter medicine \u2013 Choosing Wisely\u201d campaign has tried to raise awareness about the risks and to limit benzodiazepine and Z-drug prescriptions. In the Italian-speaking part of Switzerland, our network of public hospitals joined the campaign with the aim of avoiding unnecessary benzodiazepine and Z-drug treatments, with prescription monitoring, benchmarking and educational contributions. Considering the risks of a possible shift towards the prescription of antipsychotics, and aware of the potential role of the COVID-19 pandemic, we decided to analyse the prescription trends of antipsychotics and benzodiazepines\/Z-drugs before, during (2016\u20132017) and after the intervention.\nMETHODS: For this longitudinal study, we reactivated a continuous monitoring of inpatient benzodiazepine\/Z-drug and antipsychotics prescriptions\/deprescriptions, paused in 2018 after the end of the internal Choosing Wisely campaign, based on routinely collected observational health data. We screened all demographic, administrative and prescription data of patients admitted to the internal medicine department of the four teaching hospitals (H1-H4) belonging to the EOC (Ente Ospedaliero Cantonale) network, from the fourth quarter of 2014 to the second quarter of 2023.\nRESULTS: We analysed 74,659 hospital stays (14,645 \/ 16,083 \/ 24,285 \/ 19,646 at hospitals H1 \/ H2 \/ H3 \/ H4 respectively). The mean (\u00b1 SD) case mix (a metric that reflects the diversity, complexity and severity of the treated patients) and patient age were 1.08 \u00b1 0.14 and 73 \u00b1 2 years. 10.6% and 12.1% of patients received antipsychotics prior to admission and at discharge respectively (new prescriptions 3.3 \u00b1 0.7%; deprescriptions 13.3 \u00b1 5.2%). New prescriptions showed an upward trend, with +0.20% per year (p &lt;0.001). Patients admitted with ongoing antipsychotics therapy increased 0.36% per year (p &lt;0.001). New benzodiazepine\/Z-drug prescriptions showed a 0.20% per year decrease (p = 0.01). Patients admitted with ongoing benzodiazepine\/Z-drug therapy decreased 0.32% per year (p &lt;0.001). New antipsychotics prescriptions showed differences between hospitals, with H3 above and H2 below the average.\nCONCLUSIONS: The increase in antipsychotics quantitatively matched the decrease in benzodiazepine\/Z-drug prescribing, suggesting a shift from one to the other sedative therapy. The same trend was visible in the ongoing prescriptions at admission revealing a similar out-of-hospital approach. This suggests a change in sedative prescribing strategy rather than the choice of alternative, non-pharmacological approaches. Furthermore, the variation between similar services of different hospitals points out the consequences of local prescribing cultures and the importance of continuously monitoring and benchmarking medication prescriptions.<\/jats:p>","DOI":"10.57187\/s.3409","type":"journal-article","created":{"date-parts":[[2024,11,7]],"date-time":"2024-11-07T18:48:41Z","timestamp":1731005321000},"page":"3409","source":"Crossref","is-referenced-by-count":2,"title":["Antipsychotic, benzodiazepine and Z-drug prescriptions in a Swiss hospital network in the Choosing Wisely and COVID-19 eras: a longitudinal study"],"prefix":"10.57187","volume":"154","author":[{"given":"Vanessa","family":"Gagliano","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gloria","family":"Salemme","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4308-0405","authenticated-orcid":false,"given":"Alessandro","family":"Ceschi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Greco","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6028-2159","authenticated-orcid":false,"given":"Nicola","family":"Grignoli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5890-418X","authenticated-orcid":false,"given":"Luca","family":"Clivio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7458-7778","authenticated-orcid":false,"given":"Alessandro","family":"Merler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa","family":"Feyling Benitez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2335-4571","authenticated-orcid":false,"given":"Jvan","family":"Gianini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7470-0235","authenticated-orcid":false,"given":"Martina","family":"Zandon\u00e0","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Gabutti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"36756","published-online":{"date-parts":[[2024,11,1]]},"reference":[{"key":"89819","doi-asserted-by":"crossref","unstructured":"Schuetz P, Seres D, Lobo DN, Gomes F, Kaegi-Braun N, Stanga Z. Management of disease-related malnutrition for patients being treated in hospital. Lancet. 2021 Nov;398(10314):1927\u201338. doi: https:\/\/doi.org\/10.1016\/S0140-6736(21)01451-3","DOI":"10.1016\/S0140-6736(21)01451-3"},{"key":"89820","unstructured":"Bundesamt f\u00fcr Statistik. Patient\/innen, Hospitalisierungen. 2021; Available from: https:\/\/www.bfs.admin.ch\/bfs\/de\/home\/statistiken\/gesundheit\/gesundheitswesen\/spitaeler\/patienten-hospitalisierungen.html"},{"key":"89821","doi-asserted-by":"crossref","unstructured":"Cawood AL, Elia M, Sharp SK, Stratton RJ. Malnutrition self-screening by using MUST in hospital outpatients: validity, reliability, and ease of use. Am J Clin Nutr. 2012 Nov;96(5):1000\u20137. doi: https:\/\/doi.org\/10.3945\/ajcn.112.037853","DOI":"10.3945\/ajcn.112.037853"},{"key":"89822","doi-asserted-by":"crossref","unstructured":"\u00c1lvaro Sanz E, Garrido Siles M, Rey Fern\u00e1ndez L, Villatoro Rold\u00e1n R, Rueda Dom\u00ednguez A, Abil\u00e9s J. Nutritional risk and malnutrition rates at diagnosis of cancer in patients treated in outpatient settings: early intervention protocol. Nutrition. 2019 Jan;57:148\u201353. doi: https:\/\/doi.org\/10.1016\/j.nut.2018.05.021","DOI":"10.1016\/j.nut.2018.05.021"},{"key":"89823","doi-asserted-by":"crossref","unstructured":"Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017 Feb;36(1):49\u201364. doi: https:\/\/doi.org\/10.1016\/j.clnu.2016.09.004","DOI":"10.1016\/j.clnu.2016.09.004"},{"key":"89824","doi-asserted-by":"crossref","unstructured":"Schuetz P, Fehr R, Baechli V, Geiser M, Deiss M, Gomes F, et al. Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial. Lancet. 2019 Jun;393(10188):2312\u201321. doi: https:\/\/doi.org\/10.1016\/S0140-6736(18)32776-4","DOI":"10.1016\/S0140-6736(18)32776-4"},{"key":"89825","doi-asserted-by":"crossref","unstructured":"Deutz NE, Matheson EM, Matarese LE, Luo M, Baggs GE, Nelson JL, et al.; NOURISH Study Group. Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: A randomized clinical trial. Clin Nutr. 2016 Feb;35(1):18\u201326. doi: https:\/\/doi.org\/10.1016\/j.clnu.2015.12.010","DOI":"10.1016\/j.clnu.2015.12.010"},{"key":"89826","doi-asserted-by":"crossref","unstructured":"Wunderle C, Gomes F, Schuetz P, Stumpf F, Austin P, Ballesteros-Pomar MD, et al. ESPEN guideline on nutritional support for polymorbid medical inpatients. Clin Nutr. 2023 Sep;42(9):1545\u201368. doi: https:\/\/doi.org\/10.1016\/j.clnu.2023.06.023","DOI":"10.1016\/j.clnu.2023.06.023"},{"key":"89827","doi-asserted-by":"crossref","unstructured":"Bischoff SC, Bernal W, Dasarathy S, Merli M, Plank LD, Sch\u00fctz T, et al. ESPEN practical guideline: clinical nutrition in liver disease. Clin Nutr. 2020 Dec;39(12):3533\u201362. doi: https:\/\/doi.org\/10.1016\/j.clnu.2020.09.001","DOI":"10.1016\/j.clnu.2020.09.001"},{"key":"89828","doi-asserted-by":"crossref","unstructured":"Muscaritoli M, Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, et al. ESPEN practical guideline: clinical Nutrition in cancer. Clin Nutr. 2021 May;40(5):2898\u2013913. doi: https:\/\/doi.org\/10.1016\/j.clnu.2021.02.005","DOI":"10.1016\/j.clnu.2021.02.005"},{"key":"89829","doi-asserted-by":"crossref","unstructured":"Ghorayeb A, Darbyshire JL, Wronikowska MW, Watkinson PJ. Design and validation of a new Healthcare Systems Usability Scale (HSUS) for clinical decision support systems: a mixed-methods approach. BMJ Open. 2023 Jan;13(1):e065323. doi: https:\/\/doi.org\/10.1136\/bmjopen-2022-065323","DOI":"10.1136\/bmjopen-2022-065323"},{"key":"89830","doi-asserted-by":"crossref","unstructured":"Aubert CE, Fankhauser N, Marques-Vidal P, Stirnemann J, Aujesky D, Limacher A, et al. Patterns of multimorbidity in internal medicine patients in Swiss university hospitals: a multicentre cohort study. Swiss Med Wkly. 2019 Jun;149:w20094. doi: https:\/\/doi.org\/10.4414\/smw.2019.20094","DOI":"10.4414\/smw.2019.20094"},{"key":"89831","unstructured":"Google. Google Forms. 2023 05. [January 2024]; Available from: https:\/\/docs.google.com\/forms"},{"key":"89832","unstructured":"R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2023."},{"key":"89833","doi-asserted-by":"crossref","unstructured":"Wickham H. ggplot2: Elegant graphics for data analysis. 2016, New York: Springer-Verlag. 11-31.","DOI":"10.1007\/978-3-319-24277-4_2"},{"key":"89834","unstructured":"Gross, J. and U. Ligges, nortest: Tests for Normality. R package version, 2015. 1(4)."},{"key":"89835","doi-asserted-by":"crossref","unstructured":"Bates D, M\u00e4chler M, Bolker B, Walker S. Fitting linear mixed-effects models using lme4. J Stat Softw. 2015;67(1):1\u201348. doi: https:\/\/doi.org\/10.18637\/jss.v067.i01","DOI":"10.18637\/jss.v067.i01"},{"key":"89836","doi-asserted-by":"crossref","unstructured":"Fox J, Weisberg S. An R companion to applied regression. 3rd ed. Sage publications; 2018.","DOI":"10.32614\/CRAN.package.carData"},{"key":"89837","doi-asserted-by":"crossref","unstructured":"Fisher RA. Statistical methods for research workers. Breakthroughs in statistics: Methodology and distribution. Springer; 1970. pp. 66\u201370.","DOI":"10.1007\/978-1-4612-4380-9_6"},{"key":"89838","unstructured":"Sobotka L. Basics in clinical nutrition. 5th ed. Galen; 2020.[S.l.]."},{"key":"89839","doi-asserted-by":"crossref","unstructured":"Cano N, Fiaccadori E, Tesinsky P, Toigo G, Druml W, Kuhlmann M, et al.; DGEM (German Society for Nutritional Medicine); ESPEN (European Society for Parenteral and Enteral Nutrition). ESPEN Guidelines on Enteral Nutrition: adult renal failure. Clin Nutr. 2006 Apr;25(2):295\u2013310. doi: https:\/\/doi.org\/10.1016\/j.clnu.2006.01.023","DOI":"10.1016\/j.clnu.2006.01.023"},{"key":"89840","doi-asserted-by":"crossref","unstructured":"Fiaccadori E, Sabatino A, Barazzoni R, Carrero JJ, Cupisti A, De Waele E, et al. ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease. Clin Nutr. 2021 Apr;40(4):1644\u201368. doi: https:\/\/doi.org\/10.1016\/j.clnu.2021.01.028","DOI":"10.1016\/j.clnu.2021.01.028"},{"key":"89841","doi-asserted-by":"crossref","unstructured":"Bischoff SC, Cuerda C, Barazzoni R. Practical guidelines and apps for improvement of guideline implementation. Clin Nutr. 2020 Oct;39(10):2943\u20134. doi: https:\/\/doi.org\/10.1016\/j.clnu.2020.07.031","DOI":"10.1016\/j.clnu.2020.07.031"},{"key":"89842","doi-asserted-by":"crossref","unstructured":"Aeberhard C, Birrenbach T, Joray M, M\u00fchlebach S, Perrig M, Stanga Z. Simple training tool is insufficient for appropriate diagnosis and treatment of malnutrition: A pre-post intervention study in a tertiary center. Nutrition. 2016 Mar;32(3):355\u201361. doi: https:\/\/doi.org\/10.1016\/j.nut.2015.09.012","DOI":"10.1016\/j.nut.2015.09.012"},{"key":"89843","doi-asserted-by":"crossref","unstructured":"Reber E, Messmer Ivanova A, Cadisch P, Stirnimann J, Perrig M, Roten C, et al. Does multifaceted nutritional education improve malnutrition management? Nutrition. 2020 Oct;78:110810. doi: https:\/\/doi.org\/10.1016\/j.nut.2020.110810","DOI":"10.1016\/j.nut.2020.110810"},{"key":"89844","doi-asserted-by":"crossref","unstructured":"Wyatt JC, Wyatt SM. When and how to evaluate health information systems? Int J Med Inform. 2003 Mar;69(2-3):251\u20139. doi: https:\/\/doi.org\/10.1016\/S1386-5056(02)00108-9","DOI":"10.1016\/S1386-5056(02)00108-9"},{"key":"89845","doi-asserted-by":"crossref","unstructured":"Imoberdorf R, Meier R, Krebs P, Hangartner PJ, Hess B, St\u00e4ubli M, et al. Prevalence of undernutrition on admission to Swiss hospitals. Clin Nutr. 2010 Feb;29(1):38\u201341. doi: https:\/\/doi.org\/10.1016\/j.clnu.2009.06.005","DOI":"10.1016\/j.clnu.2009.06.005"}],"container-title":["Swiss Medical Weekly"],"original-title":[],"link":[{"URL":"https:\/\/smw.ch\/index.php\/smw\/article\/download\/3409\/6081","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/smw.ch\/index.php\/smw\/article\/download\/3409\/6082","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/smw.ch\/index.php\/smw\/article\/download\/3409\/6081","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,7]],"date-time":"2024-11-07T18:48:51Z","timestamp":1731005331000},"score":1,"resource":{"primary":{"URL":"https:\/\/smw.ch\/index.php\/smw\/article\/view\/3409"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,1]]},"references-count":27,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11,1]]}},"URL":"https:\/\/doi.org\/10.57187\/s.3409","relation":{},"ISSN":["1424-3997"],"issn-type":[{"type":"electronic","value":"1424-3997"}],"subject":[],"published":{"date-parts":[[2024,11,1]]}}}