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Navaratnam M, Vie GÅ, Brevik T, Austad B, Innerdal C, Getz LO, Skjellegrind HK. Prescription of potentially addictive medications after a multilevel community intervention in general practice. Scand J Prim Health Care 2023; 41:61-68. [PMID: 36662609 PMCID: PMC10088976 DOI: 10.1080/02813432.2023.2168125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To evaluate the long-term effects of a multilevel community intervention to improve the quality of prescription practice of potentially addictive medications (PAMs). DESIGN We conducted a retrospective study, using anonymized data from the Norwegian prescription registry. SETTING Based on an initiative from the GPs in Molde Municipality in Norway, a multilevel community intervention was initiated by the municipal chief physician in 2018. The intervention targeted GPs, patients, and the public. SUBJECTS We retrieved prescription data from 26 of 36 GPs. MAIN OUTCOME MEASURES By using the standardized defined daily dose (DDD), we compared prescription of three groups of PAMs from before the intervention (2017) throughout the intervention in 2018, and through 2020 to determine long-term effects. RESULTS Three years after the intervention, the GPs in our study sample prescribed 26% less opioids, 38% less benzodiazepines, and 16% less z-hypnotics. Overall prescription of PAMs decreased by 27%. The number of individuals receiving at least 90 DDD of benzodiazepines and z-hypnotics were reduced from 9 to 7 and 34 to 24 per 1000, respectively. Also, the number of individuals receiving two and three PAMs concomitantly were reduced. CONCLUSION Addressing prescription practice among GPs in a community as a joint intervention, combined with addressing patients and the public may be a feasible method to obtain long-term reduction of PAM prescriptions.Key pointsNon-therapeutic prescriptions of potentially addictive medications (PAMs) are both a public health concern and a frequent challenge in general practice.A multilevel community intervention, targeting general practitioners, patients, and the public, led to 27% reduction in prescription of PAMs.Both the number of daily users and concomitant use of several PAMs were reduced.The reduction in prescription persisted for three years.
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Affiliation(s)
- Muhunthan Navaratnam
- Molde Brygge General Practitioner Office, Molde Municipality, Molde, Norway
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Gunnhild Åberge Vie
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Thea Brevik
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
- Clinic of Surgery, Møre and Romsdal Hospital Trust, Molde Hospital, Molde, Norway
| | - Bjarne Austad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | | | - Linn Okkenhaug Getz
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Håvard Kjesbu Skjellegrind
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
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Yana J, Moscova L, Le Breton J, Boutin E, Siess T, Clerc P, Bastuji-Garin S, Ferrat E. Prescription of benzodiazepines and Z-drugs among older patients in primary care: a French, national, cohort study. Fam Pract 2022:cmac114. [PMID: 36308516 DOI: 10.1093/fampra/cmac114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In France, general practitioners (GPs) prescribe benzodiazepines and Z-drugs (BZD/ZDs) widely, and especially to older adults. Several characteristics of patients and/or GPs linked to BZD/ZD overprescription have been described in the general population but not among older patients in primary care. OBJECTIVES To estimate the proportion of GP consultations by patients aged 65 and over that resulted in a BZD/ZD prescription, and determine whether any GP-related factors predicted BZD/ZD overprescription in this setting. METHODS We analyzed sociodemographic and practice-related GP characteristics, and aggregated data on consultations recorded prospectively by 117 GPs in a database between 2000 and 2010. Next, we used logistic regression models to look for factors potentially associated with BZD/ZD overprescription (defined as an above-median prescription rate). RESULTS The GPs' mean age at inclusion was 47.4 (7.1), and 87.9% were male. During the study period, the median (95% confidence interval) proportion of consultations with patients aged 65 and over resulting in a BZD/ZD prescription was 21.8% (18.1-26.1) (range per GP: 5-34.1%). In a multivariable analysis, a greater number of chronic disease (OR [95% CI] = 2.10 [1.22-3.64]), a greater number of drugs prescribed per consultation (5.29 [2.72-10.28]), and shorter study participation were independently associated with BZD/ZD overprescription. CONCLUSIONS BZD/ZD overprescription was associated with a greater chronic disease burden and the number of drugs prescribed per consultation but not with any sociodemographic or practice-related GP characteristics. Targeted actions are needed to help GPs limit their prescription of BZD/ZDs to older patients with multiple comorbidities and polypharmacy.
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Affiliation(s)
- Jonathan Yana
- Univ Paris-Est Creteil, School of Medicine, Primary Care Department, F-94010 Creteil, France
- Maison de Santé pluri-professionnelle Universitaire de St-Maur des Fossés, F-94100, France
| | - Laura Moscova
- Univ Paris-Est Creteil, School of Medicine, Primary Care Department, F-94010 Creteil, France
| | - Julien Le Breton
- Univ Paris-Est Creteil, School of Medicine, Primary Care Department, F-94010 Creteil, France
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
- Société Française de Médecine Générale, Issy Les Moulineaux, F-92130, France
- Centre de santé universitaire Salvador Allende, F-93120 La Courneuve, France
| | - Emmanuelle Boutin
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
- APHP, Hopital Henri-Mondor, Unité de Recherche Clinique (URC Mondor), F-94000 Creteil, France
| | - Tiphaine Siess
- Univ Paris-Est Creteil, School of Medicine, Primary Care Department, F-94010 Creteil, France
| | - Pascal Clerc
- Société Française de Médecine Générale, Issy Les Moulineaux, F-92130, France
- Primary Care Department, Université de Versailles, School of Medicine, F-78000 Versailles, France
| | - Sylvie Bastuji-Garin
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
- Department of Public Health, APHP, Hopital Henri-Mondor, F-94000 Creteil, France
| | - Emilie Ferrat
- Univ Paris-Est Creteil, School of Medicine, Primary Care Department, F-94010 Creteil, France
- Maison de Santé pluri-professionnelle Universitaire de St-Maur des Fossés, F-94100, France
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
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The influence of prescriber and patient gender on the prescription of benzodiazepines: results from the Florida Medicaid Dataset. CNS Spectr 2022; 27:378-382. [PMID: 33461640 DOI: 10.1017/s1092852921000055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Benzodiazepine (BZD) prescription rates have increased over the past decade in the United States. Available literature indicates that sociodemographic factors may influence diagnostic patterns and/or prescription behaviour. Herein, the aim of this study is to determine whether the gender of the prescriber and/or patient influences BZD prescription. METHODS Cross-sectional study using data from the Florida Medicaid Managed Medical Assistance Program from January 1, 2018 to December 31, 2018. Eligible recipients ages 18 to 64, inclusive, enrolled in the Florida Medicaid plan for at least 1 day, and were dually eligible. Recipients either had a serious mental illness (SMI), or non-SMI and anxiety. RESULTS Total 125 463 cases were identified (i.e., received BZD or non-BZD prescription). Main effect of patient and prescriber gender was significant F(1, 125 459) = 0.105, P = 0 .745, partial η2 < 0.001. Relative risk (RR) of male prescribers prescribing a BZD compared to female prescribers was 1.540, 95% confidence intervals (CI) [1.513, 1.567], whereas the RR of male patients being prescribed a BZD compared to female patients was 1.16, 95% CI [1.14, 1.18]. Main effects of patient and prescriber gender were statistically significant F(1, 125 459) = 188.232, P < 0.001, partial η2 = 0.001 and F(1, 125 459) = 349.704, P < 0.001, partial η2 = 0.013, respectively. CONCLUSIONS Male prescribers are more likely to prescribe BZDs, and male patients are more likely to receive BZDs. Further studies are required to characterize factors that influence this gender-by-gender interaction.
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Bias Discovery in Machine Learning Models for Mental Health. INFORMATION 2022. [DOI: 10.3390/info13050237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fairness and bias are crucial concepts in artificial intelligence, yet they are relatively ignored in machine learning applications in clinical psychiatry. We computed fairness metrics and present bias mitigation strategies using a model trained on clinical mental health data. We collected structured data related to the admission, diagnosis, and treatment of patients in the psychiatry department of the University Medical Center Utrecht. We trained a machine learning model to predict future administrations of benzodiazepines on the basis of past data. We found that gender plays an unexpected role in the predictions—this constitutes bias. Using the AI Fairness 360 package, we implemented reweighing and discrimination-aware regularization as bias mitigation strategies, and we explored their implications for model performance. This is the first application of bias exploration and mitigation in a machine learning model trained on real clinical psychiatry data.
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The influence of prescriber and patient gender on the prescription of benzodiazepines: evidence for stereotypes and biases? Soc Psychiatry Psychiatr Epidemiol 2021; 56:1083-1089. [PMID: 33258001 DOI: 10.1007/s00127-020-01989-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Benzodiazepines are commonly prescribed globally. We hypothesize that gender stereotypes influence benzodiazepine prescriptions insofar as male prescribers are more likely to prescribe benzodiazepines to female patients. METHODS Our nationwide cohort study included 2,127,441 patients with a psychiatric disorder (ICD-9 codes 290-319) and 38,932 prescribers as part of the Taiwan National Health Insurance Research Database (1997-2013). We evaluated the effects of patient and prescriber gender on the proportion of patients prescribed benzodiazepines and the cumulative dosage of benzodiazepine prescription (mg) using generalized estimating equation and general linear models. RESULTS The proportion of patients prescribed benzodiazepines was higher among male (vs. female) prescribers [odds ratio (OR) = 1.06, 95% confidence interval (CI) = 1.05-1.07] and among female (vs. male) patients (OR = 1.08, 95% CI = 1.08-1.09). Similarly, male prescriber gender (β = 10,292.2, SE = 1265.5, p < 0.001) and female patient gender (β = 7913.7, SE = 627.1, p < 0.001) predicted higher cumulative dosages of benzodiazepine prescription. Mean cumulative dosage was highest among female patients seen by male prescribers (β = 4283.7, SE = 717.6, p < 0.001). The results were consistent in sensitivity analyses of patients with anxiety disorder (n = 1,632,363), major depression (n = 1,122,796), or chronic administration (n = 1,981,819), and prescribers with psychiatrists (n = 1276), and non-psychiatrists (n = 33,268). CONCLUSIONS Male prescribers were more likely to prescribe benzodiazepines to female patients relative to male patients. This gender bias in prescription is significant and warrants careful attention at point of care. We hypothesize that internalized societal biases and stereotypes affect benzodiazepine prescribing behaviour.
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Davari M, Khorasani E, Tigabu BM. Factors Influencing Prescribing Decisions of Physicians: A Review. Ethiop J Health Sci 2019; 28:795-804. [PMID: 30607097 PMCID: PMC6308758 DOI: 10.4314/ejhs.v28i6.15] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The pharmaceutical bill is increasing at an alarming rate. The physician practice variation has a pronounced effect on healthcare spending. A number of factors can influence the prescribing behavior of physicians. The aim of this review was to identify the factors affecting the prescribing decision of physicians. Methods Electronic databases including Scopus, PubMed/MEDLINE CENTRAL, Cochrane Libraries and Google scholar were searched systematically for literatures on factors influencing prescribing decisions of physicians from 2000 to 2016. There was no restriction on the study designs. Results Thirty-three studies met the inclusion criteria from 1122 search results. A total of 33 factors were identified. The most frequent factors were patients' clinical condition, pharmaceutical industries, physician attributes, patient preference and cost of medicine. Conclusion Physicians' personal attributes, cost of the medicine and pharmaceutical industries' marketing and promotion strategies were mostly mentioned to influence prescribing decision. The identified factors showed that prescribing is not only geared for patient benefit, but also towards personal interest. The use of valid and reliable practice guidelines could reduce the negative impact of wide ranges of factors and promote the rational prescribing effectively.
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Affiliation(s)
- Majid Davari
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Pharmaceutical Research Center, Tehran University of Medical Sciences
| | - Elahe Khorasani
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Pharmaceutical Research Center, Tehran University of Medical Sciences.,Faculty of Pharmacy, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bereket Molla Tigabu
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Pharmaceutical Research Center, Tehran University of Medical Sciences.,Tehran University of Medical Sciences, International Campus.,Haramaya University, School of Pharmacy, Ethiopia
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Abstract
In the United States, benzodiazepine medication use is the secondary epidemic to opioid drug use and carries serious consequences as well, even though its use is enabled by well-intended clinicians. Benzodiazepine drugs are intended for short-term use, not to exceed 2 to 4 weeks; yet, it is common for clients to be taking benzodiazepine medications for up to 10 years. In addition to dependence or addiction, adverse effects include depression, emotional blunting, ataxia, aggression, irritability, nervousness, and cognitive impairment. These medications also contribute to increased risk for falls, suicide, overdose fatality, and vehicle crashes. The current article describes the epidemiology of benzodiazepine medication use, patient and prescriber factors that contribute to overuse and misuse, and recommendations for prescribing and deprescribing. [Journal of Psychosocial Nursing and Mental Health Services, 56(6), 11-15.].
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Dunlop BW, Rakofsky JJ. Surveying Psychiatrists' Psychopharmacology Practices Across Common Clinical Scenarios. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2017; 15:445-449. [PMID: 31975878 DOI: 10.1176/appi.focus.20170029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The practice of psychopharmacology has become increasingly complex with the expansion of medication options across psychiatric conditions. The level of variability among psychiatrists in their application of medication treatments has received little attention to date. We surveyed 111 psychiatrists attending one of two annual psychiatry meetings in 2017, asking whether they agreed or disagreed with statements about psychopharmacological approaches to 14 common clinical scenarios. High consistency was found for six scenarios, which generally reflected published treatment guidelines, and in recommending that their patients avoid using marijuana. However, low consistency was found for seven scenarios, particularly for statements addressing the use of benzodiazepines and antipsychotic medications. These statements of low consistency generally reflected contradictions or ambiguity across treatment guidelines. In comparison with male psychiatrists, female psychiatrists' responses revealed greater caution around use of medications with addictive potential. Responses to statements were not associated with psychiatrists' perceived adequacy of psychopharmacology training received during residency. Although psychiatrists have high consistency in some aspects of psychopharmacological practice, significant variability exists in important areas of medication use. The consistency of psychotropic medication prescribing may be improved through conducting practical clinical trials that address the existing evidence gaps and by developing educational materials targeting areas of prescriber disagreement.
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Affiliation(s)
- Boadie W Dunlop
- Drs. Dunlop and Rakofsky are with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Jeffrey J Rakofsky
- Drs. Dunlop and Rakofsky are with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
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Rat C, Werner EL, Pivette J, Senand R, Nguyen JM. Hypnotic prescription without face to face contact: A report from French family medicine. Eur J Gen Pract 2013; 19:158-61. [DOI: 10.3109/13814788.2013.777423] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Stene LE, Dyb G, Tverdal A, Jacobsen GW, Schei B. Intimate partner violence and prescription of potentially addictive drugs: prospective cohort study of women in the Oslo Health Study. BMJ Open 2012; 2:e000614. [PMID: 22492384 PMCID: PMC3323816 DOI: 10.1136/bmjopen-2011-000614] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the prescription of potentially addictive drugs, including analgesics and central nervous system depressants, to women who had experienced intimate partner violence (IPV). DESIGN Prospective population-based cohort study. SETTING Information about IPV from the Oslo Health Study 2000/2001 was linked with prescription data from the Norwegian Prescription Database from 1 January 2004 through 31 December 2009. PARTICIPANTS The study included 6081 women aged 30-60 years. MAIN OUTCOME MEASURES Prescription rate ratios (RRs) for potentially addictive drugs derived from negative binomial models, adjusted for age, education, paid employment, marital status, chronic musculoskeletal pain, mental distress and sleep problems. RESULTS Altogether 819 (13.5%) of 6081 women reported ever experiencing IPV: 454 (7.5%) comprised physical and/or sexual IPV and 365 (6.0%) psychological IPV alone. Prescription rates for potentially addictive drugs were clearly higher among women who had experienced IPV: crude RRs were 3.57 (95% CI 2.89 to 4.40) for physical/sexual IPV and 2.13 (95% CI 1.69 to 2.69) for psychological IPV alone. After full adjustment RRs were 1.83 (1.50 to 2.22) for physical/sexual IPV, and 1.97 (1.59 to 2.45) for psychological IPV alone. Prescription rates were increased both for potentially addictive analgesics and central nervous system depressants. Furthermore, women who reported IPV were more likely to receive potentially addictive drugs from multiple physicians. CONCLUSIONS Women who had experienced IPV, including psychological violence alone, more often received prescriptions for potentially addictive drugs. Researchers and clinicians should address the possible adverse health and psychosocial impact of such prescription and focus on developing evidence-based healthcare for women who have experienced IPV.
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Affiliation(s)
- Lise Eilin Stene
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Grete Dyb
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Aage Tverdal
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Geir Wenberg Jacobsen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Berit Schei
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynaecology, St Olavs University Hospital, Trondheim, Norway
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Vevatne T, Selbekk AS, Sand R. [Addictive drugs prescription practice among general practitioners]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2010; 130:1925-7. [PMID: 20930881 DOI: 10.4045/tidsskr.08.0668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Rogaland A-senter, Norway has investigated prescription and cessation of benzodiazepine and minor opiates among GPs, and examined their need for external help to deal with this issue. MATERIAL AND METHODS A questionnaire, to be completed anonymously, was sent to all GPs in Rogaland county in spring 2008. RESULTS 44% (134) of GPs responded to the survey. All GPs who responded had patients who seemed to use (based on renewal frequency of prescriptions) benzodiazepines or minor opiates on a daily basis. 94% (126) of GPs had patients for whom they doubted the treatment's usefulness. 99% (132) of GPs had attempted cessation, but their patients often lacked motivation. 70% of GPs responded that external help would be useful, both for patients (treatment possibilities) and themselves (guidance, support and knowledge). INTERPRETATION The results indicate that treatment of patients using benzodiazepine and minor opiates requires a closer cooperation between different levels of health services (primary and specialist).
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Affiliation(s)
- Terje Vevatne
- Forsknings- og utviklingsavdelingen, Rogaland A-senter, Postboks 5001 Dusavik, 4084 Stavanger, Norway.
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Siriwardena AN, Apekey T, Tilling M, Dyas JV, Middleton H, Ørner R. General practitioners' preferences for managing insomnia and opportunities for reducing hypnotic prescribing. J Eval Clin Pract 2010; 16:731-7. [PMID: 20545802 DOI: 10.1111/j.1365-2753.2009.01186.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Insomnia and sleep problems are common with many sufferers seeking medical help from general practitioners (GPs) whose clinical response is limited, often involving prescription of hypnotic drugs. The case for improving the quality of care for patients with insomnia is compelling but there is little evidence about how better care could be achieved in a primary care setting. The aim of this study was to investigate GPs' management preferences for sleep problems and their awareness and perception of opportunities for improving care as well as reducing the use of benzodiazepines and Z drugs. METHODS Cross-sectional survey of GPs using a self-administered postal questionnaire in 2005 to all GPs in West Lincolnshire Primary Care Trust Lincolnshire, UK. RESULTS A total of 84 of 107 (78.5%) questionnaires sent to GP principals were returned after one reminder. Respondents favoured Z drugs over benzodiazepines for the majority of indications. Respondent attitudes to benzodiazepines and Z drugs were generally negative whereas they were positive towards initiatives to reduce hypnotic prescribing through personal guidance, awareness-raising strategies and organizational interventions. CONCLUSIONS GPs were negative in attitude towards hypnotics and positive towards reducing prescribing for sleep problems. They need to develop resources and better strategies for assessment and non-pharmacological management of patients presenting with insomnia for the first time as well as those on long-term hypnotics. The feasibility and effectiveness of psychosocial interventions tailored to patient and service needs in primary care setting should be evaluated systematically seeking to understand potential clinical benefits as well as potential undesirable effects of service changes.
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Affiliation(s)
- A Niroshan Siriwardena
- Faculty of Health, Life & Social Sciences, University of Lincoln, Brayford Pool, Lincoln, UK.
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Prescription of benzodiazepines in Slovenian family medicine: a qualitative study. Wien Klin Wochenschr 2010; 122:474-8. [PMID: 20658195 DOI: 10.1007/s00508-010-1413-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2009] [Accepted: 07/05/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Previous quantitative research showed large variations in prescribing volume and prescribing patterns of benzodiazepines among Slovenian family physicians. We performed a qualitative interview study to investigate how high-prescribing family physicians explain their own prescription. METHODS Five family physicians with benzodiazepine prescriptions in volumes larger than 4000 defined daily doses per month and five who prescribed volumes smaller than 2000 defined daily doses per month, selected randomly from the representative sample of Slovenian family physicians, were interviewed. Physicians' self-explanations about their daily decisions regarding benzodiazepine prescribing, patients' and practice characteristics and their attitudes towards patients were analysed. RESULTS Family physicians were reporting about patients' needs and their demands, co-morbidity of older patients, previous good experience with benzodiazepines, concerns about decreasing dosage or discontinuation of benzodiazepines, high workload and time constraints, limited access to mental health workers and insufficient education and training. CONCLUSION Family physicians consider the task of initiating, withdrawing or reducing benzodiazepines as demanding due to complexity of psychosocial problems, co-morbidity, workload, time-consumingness, need to master counselling skills, demands of their patients, particularly the long-term ones and due to low access to mental health services. The majority of family physicians agreed with restrictions in their prescription based on the guidelines.
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Magic bullets for insomnia? Patients' use and experiences of newer (Z drugs) versus older (benzodiazepine) hypnotics for sleep problems in primary care. Br J Gen Pract 2008; 58:417-22. [PMID: 18505619 DOI: 10.3399/bjgp08x299290] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Little is known about patients' perceptions of newer hypnotics. AIM To investigate use, experience, and perceptions of Z drug and benzodiazepine hypnotics in the community. DESIGN OF STUDY Cross-sectional survey of general practice patients who had received at least one prescription for a Z drug or benzodiazepine in the previous 6 months. SETTING Lincolnshire, UK. METHOD Self-administered postal questionnaire. RESULTS Of 1600 surveys posted, 935 (58.4%) responses were received, of which 705 (75.4%) were from patients taking drugs for insomnia. Of those 705 patients, 87.9% (n = 620) were first prescribed a hypnotic by their GP, and 94.9% (n = 669) had taken a sleeping tablet for 4 weeks or more. At least one side effect was reported in 41.8% (n = 295); 18.6% wished to come off hypnotic medication; and 48.5% had tried to stop treatment. Patients on Z drugs were more likely to express a wish to stop (22.7% versus 12.3%; odds ratio [OR] = 1.67, 95% confidence interval [CI] = 1.13 to 2.49), or to have attempted to come off medication, than those on benzodiazepines (52.4% versus 41.0%; OR = 1.54, 95% CI = 1.12 to 2.12). The two groups did not differ significantly in respect of benefits or adverse effects. CONCLUSION There were no significant differences in patients' perceptions of efficacy or side-effects reported by those on Z drugs compared to patients taking benzodiazepines. Side-effects were commonly reported, which may have contributed to a high proportion of responders, particularly patients on Z drugs who were wishing to stop, or who had previously tried to stop taking this medication. Reported prescribing practices were often at variance with the licence for short-term use.
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Anthierens S, Habraken H, Petrovic M, Christiaens T. The lesser evil? Initiating a benzodiazepine prescription in general practice: a qualitative study on GPs' perspectives. Scand J Prim Health Care 2007; 25:214-9. [PMID: 18041658 PMCID: PMC3379762 DOI: 10.1080/02813430701726335] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Chronic benzodiazepine (BZD) use is widespread and linked with adverse effects. There is consensus concerning the importance of initiating BZD as a crucial moment. Nevertheless specific research in this field is lacking. This paper addresses the views of GPs on why they start prescribing BZDs to first-time users. DESIGN Qualitative study with five focus groups analysed using a systematic content analysis. SETTING Regions of Ghent and Brussels in Belgium. SUBJECTS A total of 35 general practitioners. MAIN OUTCOME MEASURE The GPs' perspective on their initiating of BZD prescribing. RESULTS GPs reported that they are cautious in initiating BZD usage. At the same time, GPs feel overwhelmed by the psychosocial problems of their patients. They show empathy by prescribing. They feel in certain situations there are no other solutions and they experience BZDs as the lesser evil. They admit to resorting to BZDs because of time restraint and lack of alternatives. GPs do not perceive the addictive nature of BZD consumption as a problem with first-time users. GPs do not specifically mention patients' demand as an element for starting. CONCLUSION The main concern of GPs is to help the patient. GPs should be aware of the addictive nature of BZD even in low doses and a non-pharmacological approach should be seen as the best first approach. If GPs decide to prescribe a BZD they should make plain to the patient that the medication is only a "temporary" solution with clear agreements with regard to medication withdrawal.
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Affiliation(s)
- Sibyl Anthierens
- Department of General Practice and Primary Health Care, Ghent University, Gent, Belgium.
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Stewart R, Niessen WJM, Broer J, Snijders TAB, Haaijer-Ruskamp FM, Meyboom-De Jong B. General Practitioners reduced benzodiazepine prescriptions in an intervention study: a multilevel application. J Clin Epidemiol 2007; 60:1076-84. [PMID: 17884604 DOI: 10.1016/j.jclinepi.2006.11.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Revised: 09/02/2006] [Accepted: 11/09/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study investigated the effects of general practitioner, patient, and prescription characteristics on the reduction of long-term benzodiazepine prescribing by sending a letter to chronic users. The data were analyzed with a method respecting the hierarchical data structure. STUDY DESIGN AND SETTING Data were obtained from 8,170 chronic users nested in 147 general practices. One thousand two hundred fifty-six chronic users in 19 general practices received a letter with the advice to reduce or stop the use of benzodiazepines after the general practitioners had attended a course on benzodiazepine use. In a three-level random intercept multilevel regression model, long-term prescribing of benzodiazepines was the dependent variable. RESULTS The reduction in benzodiazepine prescribing was significantly larger in the intervention than in the control group: 16% after 6 months and 14% after 12 months, respectively. The age of the patient, gender, and the interaction between age and gender were significant. The combination of the duration (long acting or short acting) with the type of benzodiazepine (anxiolytic or hypnotic) was an important pharmacological baseline covariate. CONCLUSIONS The reduction of benzodiazepine prescribing was mainly explained by the letter intervention and individual patient characteristics. Multilevel analysis was a worthwhile method for application in this study with its unbalanced design.
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Affiliation(s)
- Roy Stewart
- University Medical Center Groningen, University of Groningen, Department of Public Health, 9713 AV Groningen, Netherlands.
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Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2004; 12:699-714. [PMID: 14762987 DOI: 10.1002/pds.933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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