Changes in Australian Early-Career General Practitioners’ Benzodiazepine Prescribing: a Longitudinal Analysis

Magin, Parker; Tapley, Amanda; Dunlop, Adrian; Davey, Andrew; Driel, Mieke van; Holliday, Elizabeth G.; Morgan, Simon; Henderson, Kim; Ball, Jean; Catzikiris, Nigel; Mulquiney, Katie; Spike, Neil; Kerr, Rohan; Holliday, Simon

doi:10.1007/s11606-018-4577-5

Cited by 11 publications

(10 citation statements)

References 39 publications

(42 reference statements)

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“…9,10 Evidence about drug prescribing for insomnia usually come from either small surveys or studies using drug dispensing data. 14,27,28 In the United States, data from the National Health and Nutrition Examination Survey (1999-2010) revealed that 3% of adults used prescribed medications for insomnia management, especially in older adults. 29 In Australia, a crosssectional analysis of 645 Australian general practitioner trainees' data (2010-2013) showed that BZD comprised 2.2% of all prescriptions, with 28.2% of them associated with an insomnia diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Trends in the prescription of drugs used for insomnia: an open-cohort study in Australian general practice, 2011–2018

et al. 2021

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Background: Despite an increase in the prevalence of sleep problems, few studies have investigated changes in the prescribing of drugs often used for managing insomnia. Aim: To explore changes in the pattern of benzodiazepine (BZD), z-drugs (zolpidem, zopiclone) and non-BZD prescriptions. Design and Setting: Open cohort study including 1,773,525 patients (55,903,294 consultations) regularly attending 404 Australian general practices from 2011-2018 (MedicineInsight). Method: Prescription rates per 1,000 consultations, the proportion of repeat prescriptions above recommendations, and the proportion of prescriptions for patients with a recent recorded insomnia diagnosis (i.e. within 2 years) were analysed using adjusted regression models. Results: Rates of BZD, z-drugs and non-BZD prescriptions were 56.6, 4.4 and 15.5/1,000 consultations in 2011 and 41.8, 3.5 and 21.5/1000 consultations in 2018, respectively. Temazepam represented 25.3% of the prescriptions and diazepam 21.9%. All BZD and zolpidem prescriptions declined from 2011-2018 [annual change varying from -1.4% to -10.8%], while non-BZD and zopiclone prescriptions increased in the same period [annual change: +5.0% to +22.6%]. Repeat prescriptions above recommendations remained below 10% for most medications, except melatonin (64.5%), zolpidem (63.3%), zopiclone (31.4%) and alprazolam (13.3%). In 2018, almost 50% of z-drugs and melatonin prescriptions were for patients with insomnia. There was 3.2%-5.9% annual increase in the proportion of prescriptions associated with a recently recorded insomnia diagnosis. Conclusion: Overall, BZD prescriptions in Australia declined from 2011-2018. However, the prescription of some of these drugs increased for patients with a recently recorded insomnia diagnosis. This is concerning because of potential adverse effects and risk of dependence.

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Section: Introductionmentioning

confidence: 99%

Trends in the prescription of drugs used for insomnia: an open-cohort study in Australian general practice, 2011–2018

et al. 2021

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Section: Discussionmentioning

confidence: 99%

“…As Magin and his colleagues contended, changing individual prescriber behaviour will require continuous education. However, they also note that such deprescribing programmes have been designed and implemented successfully to reduce inappropriate antibiotic prescribing (Magin et al, 2018). Additionally, programmes directed at clinicians reducing polydrug prescriptions involving BZDs and other drugs, especially opiates, and providing patient education may play an important role in lowering the risk of overdose deaths and over‐prescribing (Parr et al, 2006, 2011; Zoorob, 2018).…”

Section: Discussionmentioning

confidence: 99%

Community‐based counselling for benzodiazepine withdrawal: A mixed‐methods study of client outcomes

Wurf

O’Neal

2022

Couns and Psychother Res

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Despite adverse health outcomes being associated with long‐term tranquilliser use, health professionals face numerous barriers in reducing reliance on benzodiazepines. This study investigated the effectiveness of focused counselling in facilitating benzodiazepine withdrawal. In phase one of a two‐phase mixed‐methods evaluation, preintervention and postintervention quantitative data for 24 participants were analysed. Measures included the Australian Treatment Outcome Profile, Kessler 10, and two client outcome ratings. In phase two, follow‐up individual interviews were conducted with six participants. Following counselling, 88% of participants reported either reduced use or withdrawal from benzodiazepines. Significant reductions in psychological distress were obtained in Kessler 10 scores, and the calculated effect size (d = 0.84) was large. Medically supervised tapering was well received when combined with focused counselling. We found strong support for the tapering process and for the appropriateness of counselling. Withdrawal was facilitated when services were well coordinated and the client's sense of control was maintained.

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“…Unsuccessful attempts at collaboration with prescribers reinforce research suggesting that targeted education about the adverse health effects of long‐term benzodiazepine use is necessary for GPs and that physicians need to advise patients of non‐pharmacological options to manage sleep and anxiety problems (Magin et al., 2018; Parr et al., 2006). The fact that inappropriate long‐term prescribing continues despite the guidelines and research discouraging it highlights the role of counsellors in supporting and advocating for individuals with benzodiazepine dependence.…”

Section: Discussionmentioning

confidence: 99%

Interventions for benzodiazepine withdrawal: Perceptions of benzodiazepine counsellors

Wurf

Swing

2021

Couns and Psychother Res

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Governments have been urged to adopt real-time prescription monitoring in order to manage and reduce risks associated with the long-term use of sleep and anti-anxiety medications. Given this imperative, accessible psychological interventions for benzodiazepine (BZD) dependency and withdrawal are essential. The aim of this study was to understand how counsellors support clients assessed as suitable for communitybased drug withdrawal services to reduce their BZD use. Six BZD counsellors and two service coordinators were interviewed. Counsellors collaborated with their clients and prescribing doctors to develop individualised taper schedules that were in line with recommended clinical guidelines. Psychoeducation underscored a range of evidence-based interventions, and a trauma-informed approach was considered essential in working with clients to reduce their use of BZDs. Continuity in care was affected by the degree of prescribing doctor support for the taper. Counsellors reported that workforce sustainability was enhanced by quality clinical supervision and professional development opportunities. The role of counsellors in providing accessible, community-based interventions for clients to reduce their use of BZDs was supported. Psychosocial support, combined with a medically supervised taper, has a strong evidence base and implications for client-centred interventions are discussed.

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Changes in Australian Early-Career General Practitioners’ Benzodiazepine Prescribing: a Longitudinal Analysis

Abstract: Despite a welcome temporal trend for reductions in overall benzodiazepine prescribing from 2010 to 2015, there is still room for improvement and our findings suggest a lack of effect of specific GP vocational training program education and, thus, an opportunity for targeted education.

Cited by 11 publications

References 39 publications

Trends in the prescription of drugs used for insomnia: an open-cohort study in Australian general practice, 2011–2018

Trends in the prescription of drugs used for insomnia: an open-cohort study in Australian general practice, 2011–2018

Community‐based counselling for benzodiazepine withdrawal: A mixed‐methods study of client outcomes

Interventions for benzodiazepine withdrawal: Perceptions of benzodiazepine counsellors

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