High benzos rate for inner city and suburbs than in county

Anti-anxiety drugs are far more widely prescribed in parts of Cork’s inner city and some of its satellite towns than in West Cork, according to a new report on the quality and safety of healthcare.

In Cork North Lee, the prescription rate for benzodiazepines (benzos) is 92.2 per 1,000 patients aged 65 and over who are eligible to have their drug costs covered under community drugs schemes.

The prescription rate in West Cork per 1,000 patients is just over half that of North Lee, at 52.2.

The lowest rate in the country, 49.1 per 1,000 patients, is in Dublin South, while West Kerry is also low at 57 per 1,000.

The figures relate to patients aged 65 and over who have a benzo dispensed for 12 months or more under community drugs schemes.

Women are prescribed far more benzos: In 2017 the prescription rate for women was almost 100 per 1,000 patients, compared to a rate of circa 45 per 1,000 for men.

Professor Anthony Staines, of the Department of Nursing and Human Sciences in Dublin City University, told RTÉ radio: “We need a programme to get people off benzodiazepine.”

He said in Ireland 7.5% of people aged over 65 have been on benzos for more than a year when the recommended duration is one month.

The report says Ireland reports “the highest rate of chronic benzodiazepine prescription in the OECD”, although data was not available for all the OECD countries.

Benzos are often prescribed for older adults for anxiety and sleep disorders, despite the risk of adverse side effects such as fatigue, dizziness, and confusion. Long-term use of benzos can lead to adverse events such as falls, road accidents, and overdose, dependence, and dose escalation.

The report also looked at death rates in hospitals within 30 days of patients being admitted following haemorrhagic stroke (caused by bleeding) and ischaemic stroke (blood clot). It found in 2016, the mortality rate within 30 days of admission with haemorrhagic stroke in Ireland was 24.6 per 100 cases, above the OECD average of 22.8 deaths per 100 cases.

Three hospitals — Naas General, St Lukes General in Kilkenny, and Galway University Hospital — were adjudged to have mortality rates that are “statistically significantly higher than the national rate”.

The report says there may be many reasons why a hospital would have higher or lower rates than the national average, including differences in types of patients, and that it “cannot be concluded that a high mortality rate is indicative of poor quality care”.

The report notes that care in stroke units “improves outcomes and reduces mortality for all groups and subtypes of stroke” but that only 70% of acute stroke cases nationally were admitted to a stroke unit — well below the 90% target.

The report says some sites report that a lack of acute stroke unit beds “remain a challenge”, such as at Cork University Hospital (CUH).

The report also looks at in-hospital waiting time for hip fracture surgery, specifically the proportion of patients aged 65 and older with a hip fracture who have surgery within two days of admission.

The HSE has a target which states that 95% of emergency hip fracture surgeries should be carried out within 48 hours as outcomes for patients are better if surgery is timely.

However, during the three-year period 2016-2018 hospital rates varied considerably. In St Vincent’s University Hospital, 97.3% surgeries were conducted in the target time, compared to 73.8% in University Hospital Limerick and 76.4% at CUH.

Wicklow has lowest vaccine uptake

• Co Wicklow had the lowest uptake rates for two children’s vaccines: the MMR vaccine (measles, mumps, rubella) at 84% and Men C vaccine (meningococcal C) at 82%, compared to a national rate of 92%.
• Roscommon had the highest uptake rates, at 94% for MenC and 96% for MMR.
• Uptake rates of the influenza vaccine was low among healthcare workers, at just 39%, lowest among nursing staff at 36% and highest among medical and dental staff at 53%.
• The uptake rate for the vaccine among the over 65s has not exceeded 60% in the past four years.
• Co Kerry fared better than most when it comes to respiratory disease. It had the lowest hospitalisation rate in the country for chronic obstructive pulmonary disorder and also for asthma.
• The chronic obstructive pulmonary disorder (COPD) hospitalisation rate per 100,000 in Co Kerry was 224.6, compared to Co Offaly which had the highest rate of 552 per 100,000.
• During the three-year period 2016-2018, there were 23 hospitalisations per 100,000 for asthma in Co Kerry compared to 67 per 100,000 population in Co Donegal, an almost three-fold variation.
• Cavan General Hospital had the highest rate of C-sections at 38.4% of births, compared to 27.2% at the National Maternity hospital, Holles St and 31.6% at Cork University Maternity Hospital.
• Bantry General had the highest death rate within 30 days of admission for heart attack.
• The volume of antibiotics consumed in hospitals annually has increased over the last 10 years. Ireland ranked ninth highest in community antibiotic consumption in Europe.

Source: The National Healthcare Quality Reporting System