Prescribed daily doses and ‘risk factors’ associated with the use of benzodiazepines in primary care

Abstract

Objective To assess the extent, characteristics and determinants of benzodiazepine prescription in outpatient Primary Health Care. Methods A clinical audit of a stratified random sample of Primary Health Care Centres in the seven islands and 1.6 million inhabitants region of ‘Canarias’ in Spain was carried out. From those centres, a random sample of 1045 clinical records was reviewed and information on diagnosis, prescription and prescribed dosages was collected in a structured questionnaire. A multivariate logistic regression analysis was performed in order to determine the ‘risk factors’ for the use of benzodiazepines. Results Benzodiazepine prescription was recorded in 23.4% of all clinical records; 87.7% of these were for benzodiazepines classified as anxiolytics (N05B) and 12.3% for hypnotics (N05C2). Benzodiazepine prescription was more common for women, elderly, widowed, divorced, low educational background, housewives and retired people. Using multivariate logistic regression, the probability of benzodiazepine prescription was found to be closely related to age, gender and employment status, but not with educational level. Prescribed Daily Doses were lower than Defined Daily Doses (DDD) in 77.1% of all anxiolytic prescriptions, but were in agreement with DDD in 90% of hypnotic prescriptions. The duration of treatment recorded in the clinical records was 25±21 months, with a range of 1 and 144 months. General Practitioners were responsible for 67% of all benzodiazepine prescription. Anxiolytics were prescribed as a single daily dose in 57% of the cases, and only ‘at supper’ in 48.6%. Conclusion In the general population attending Primary Health Care Centres of the Canary Islands Health System the prescription of benzodiazepines is higher for women and the elderly, and the most common use is chronic, with a duration of over 2 years in most cases. Anxiolytics are prescribed in doses which are much lower than those used as DDD and were used only ‘at night’ in almost half of the cases. This could represent an overlapping of the indications with hypnotics, and explain part of the huge difference in the use of anxiolytics in Spain compared with other figures in Europe. This fact must also be taken into account when making inferences of benzodiazepine use from sales statistics, which are very imprecise measures of drug use. Copyright © 1999 John Wiley & Sons, Ltd.

The Severity of Dependence Scale (SDS) as screening test for benzodiazepine dependence: SDS validation study

“…We used a prevalence rate of 30% to compute the predictive power of the SDS. This prevalence ® gure was obtained from previous studies in the same setting 17,18 and is in accordance with ® gures from other authors. 7 The relationship between the true-positive and false-positive rates is demonstrated in a ROC curve, which is a plot of these two rates for a range of cut-off values.…”

General Practitioners’ Perspectives Over Solutions To Change BZD Prescription Trends – A Qualitative Study

“…Addressing human resources needs, and speci cally the need to hire more GPs, was considered a crucial issue to change BZDs prescribing patterns and improve the quality of mental health care in primary health care settings. In fact, the arguments used by the participant GPs to justify this suggested solution are consistent with other research, which reports dissatisfaction among GPs with their large patient loads and perceived work overload [2,15,38].…”

“…Regarding training in mental health most studies agree with our data, mentioning that there is a general need for better training of GPs [15]. The suggestion of our GP participants that there be regular compulsory training for GPs, as exists in other European countries [42], would probably be a more feasible and cost-effective solution than the implementation of regular meetings between GPs and psychiatry specialists in the short-term.…”

Implementing an online program to change benzodiazepine prescription in Portugal: a cluster randomized trial

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“…These findings are similar to what is found in other studies, [44][45][46][47] and can be explained by the higher prevalence of insomnia, anxiety disorders, and organic conditions elders present, together with a more frequent demand for medical attention. 45 BZD prescription should be avoided at older ages considering its secondary effects such as increased number of falls and bone fractures, [3][4][5] cognitive decline, and dementia. [10][11][12] These recommendations were highlighted in ePrimaPrescribe program modules' content, hence we expected a positive effect coming from the program's implementation, with a decrease in prescription, which was not observed.…”