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Turner A, van Driel ML, Mitchell BL, Davis JS, Fielding A, Davey A, Holliday E, Ball J, Ralston A, Tapley A, Mulquiney K, Baillie EJ, Spike N, Clarke L, Magin P. Temporal patterns of antibiotic prescribing for sore throat, otitis media, and sinusitis: a longitudinal study of general practitioner registrars. Fam Pract 2024; 41:283-291. [PMID: 37226282 PMCID: PMC11167965 DOI: 10.1093/fampra/cmad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Antibiotics provide minimal benefit for sore throat, otitis media, and sinusitis. Antibiotic stewardship, with reduced prescribing, is required to address antibiotic resistance. As most antibiotic prescribing occurs in general practice and prescribing habits develop early, general practitioner (GP) trainees (registrars) are important for effective antibiotic stewardship. OBJECTIVES To establish temporal trends in Australian registrars' antibiotic prescribing for acute sore throat, acute otitis media, and acute sinusitis. DESIGN A longitudinal analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study from 2010 to 2019. PARTICIPANTS ReCEnT is an ongoing cohort study of registrars' in-consultation experiences and clinical behaviours. Pre-2016, 5 of 17 Australian training regions participated. From 2016, 3 of 9 regions (42% of Australian registrars) participate. MAIN MEASURES The outcome was prescription of an antibiotic for a new acute problem/diagnosis of sore throat, otitis media, or sinusitis. The study factor was year (2010-2019). KEY RESULTS Antibiotics were prescribed in 66% of sore throat diagnoses, 81% of otitis media, and in 72% of sinusitis. Prescribing frequencies decreased between 2010 and 2019 by 16% for sore throat (from 76% to 60%) by 11% for otitis media (from 88% to 77%) and by 18% for sinusitis (from 84% to 66%). In multivariable analyses, "Year" was associated with reduced prescribing for sore throat (OR 0.89; 95%CI 0.86-0.92; p < 0.001), otitis media (OR 0.90; 95%CI 0.86-0.94; p < 0.001), and sinusitis (OR 0.90; 95%CI 0.86, 0.94; p < 0.001). CONCLUSIONS Registrars' prescribing rates for sore throat, otitis media, and sinusitis significantly decreased during the period 2010-2019. However, educational (and other) interventions to further reduce prescribing are warranted.
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Affiliation(s)
- Alexandria Turner
- Faculty of Medicine, General Practice Clinical Unit, The University of Queensland, Brisbane, Australia
- NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Newcastle, Australia
| | - Mieke L van Driel
- Faculty of Medicine, General Practice Clinical Unit, The University of Queensland, Brisbane, Australia
| | - Benjamin L Mitchell
- Faculty of Medicine, General Practice Clinical Unit, The University of Queensland, Brisbane, Australia
| | - Joshua S Davis
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Alison Fielding
- NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Andrew Davey
- NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Anna Ralston
- NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Amanda Tapley
- NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Katie Mulquiney
- NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Emma J Baillie
- Faculty of Medicine, General Practice Clinical Unit, The University of Queensland, Brisbane, Australia
| | - Neil Spike
- Eastern Victoria General Practice Training, Regional Training Organisation, Hawthorn, Australia
- Department of General Practice and Primary Health Care, University of Melbourne, Carlton, Australia
- School of Rural Health, Monash University, Clayton, Australia
| | - Lisa Clarke
- General Practice Training Tasmania, Regional Training Organisation, Hobart, Australia
| | - Parker Magin
- NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
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Ralston A, Fielding A, Holliday E, Ball J, Tapley A, van Driel M, Davey A, Turner R, Moad D, FitzGerald K, Spike N, Mitchell B, Tran M, Fisher K, Magin P. 'Low-value' clinical care in general practice: a cross-sectional analysis of low-value care in early-career GPs' practice. Int J Qual Health Care 2023; 35:0. [PMID: 37757860 DOI: 10.1093/intqhc/mzad081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/11/2023] [Accepted: 09/27/2023] [Indexed: 09/29/2023] Open
Abstract
Nonevidence-based and 'low-value' clinical care and medical services are 'questionable' clinical activities that are more likely to cause harm than good or whose benefit is disproportionately low compared with their cost. This study sought to establish general practitioner (GP), patient, practice, and in-consultation associations of an index of key nonevidence-based or low-value 'questionable' clinical practices. The study was nested in the Registrar Clinical Encounters in Training study-an ongoing (from 2010) cohort study in which Australian GP registrars (specialist GP trainees) record details of their in-consultation clinical and educational practice 6-monthly. The outcome factor in analyses, performed on Registrar Clinical Encounters in Training data from 2010 to 2020, was the score on the QUestionable In-Training Clinical Activities Index (QUIT-CAI), which incorporates recommendations of the Australian Choosing Wisely campaign. A cross-sectional analysis used negative binomial regression (with the model including an offset for the number of times the registrar was at risk of performing a questionable activity) to establish associations of QUIT-CAI scores. A total of 3206 individual registrars (response rate 89.9%) recorded 406 812 problems/diagnoses where they were at risk of performing a questionable activity. Of these problems/diagnoses, 15 560 (3.8%) involved questionable activities being performed. In multivariable analyses, higher QUIT-CAI scores (more questionable activities) were significantly associated with earlier registrar training terms: incidence rate ratios (IRRs) of 0.91 [95% confidence interval (CI) 0.87, 0.95] and 0.85 (95% CI 0.80, 0.90) for Term 2 and Term 3, respectively, compared to Term 1. Other significant associations of higher scores included the patient being new to the registrar (IRR 1.27; 95% CI 1.12, 1.45), the patient being of non-English-speaking background (IRR 1.24; 95% CI 1.04, 1.47), the practice being in a higher socioeconomic area decile (IRR 1.01; 95% CI 1.00, 1.02), small practice size (IRR 1.05; 95% CI 1.00, 1.10), shorter consultation duration (IRR 0.99 per minute; 95% CI 0.99, 1.00), and fewer problems addressed in the consultation (IRR 0.84; 95% CI 0.79, 0.89) for each additional problem]. Senior registrars' clinical practice entailed less 'questionable' clinical actions than junior registrars' practice. The association of lower QUIT-CAI scores with a measure of greater continuity of care (the patient not being new to the registrar) suggests that continuity should be supported and facilitated during GP training (and in established GPs' practice).
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Affiliation(s)
- Anna Ralston
- The University of Newcastle, School of Medicine and Public Health, University Dr, Callaghan, NSW 2308, Australia
- GP Synergy, NSW & ACT Research and Evaluation Unit, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304, Australia
| | - Alison Fielding
- The University of Newcastle, School of Medicine and Public Health, University Dr, Callaghan, NSW 2308, Australia
- GP Synergy, NSW & ACT Research and Evaluation Unit, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304, Australia
| | - Elizabeth Holliday
- The University of Newcastle, School of Medicine and Public Health, University Dr, Callaghan, NSW 2308, Australia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305, Australia
| | - Amanda Tapley
- The University of Newcastle, School of Medicine and Public Health, University Dr, Callaghan, NSW 2308, Australia
- GP Synergy, NSW & ACT Research and Evaluation Unit, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304, Australia
| | - Mieke van Driel
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, 288 Herston Road, Herston, QLD 4006, Australia
| | - Andrew Davey
- The University of Newcastle, School of Medicine and Public Health, University Dr, Callaghan, NSW 2308, Australia
- GP Synergy, NSW & ACT Research and Evaluation Unit, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304, Australia
| | - Rachel Turner
- GP Synergy, NSW & ACT Research and Evaluation Unit, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304, Australia
| | - Dominica Moad
- The University of Newcastle, School of Medicine and Public Health, University Dr, Callaghan, NSW 2308, Australia
- GP Synergy, NSW & ACT Research and Evaluation Unit, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304, Australia
| | - Kristen FitzGerald
- General Practice Training Tasmania (GPTT), Level 3, RACT House, 179 Murray Street, Hobart, TAS 7000, Australia
- University of Tasmania, School of Medicine, Level 1, Medical Science 1, 17 Liverpool Street, Hobart, TAS 7000, Australia
| | - Neil Spike
- Eastern Victoria General Practice Training (EVGPT), 15 Cato Street, Hawthorn, VIC 3122, Australia
- Department of General Practice and Primary Health Care, University of Melbourne, 200 Berkeley Street, Carlton, VIC 3053, Australia
- Monash University, School of Rural Health, Building 20/26 Mercy St, Bendigo, VIC 3550, Australia
| | - Ben Mitchell
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, 288 Herston Road, Herston, QLD 4006, Australia
| | - Michael Tran
- University of New South Wales, School of Population Health, High Street and Botany Road, Kensington, NSW 2052, Australia
| | - Katie Fisher
- The University of Newcastle, School of Medicine and Public Health, University Dr, Callaghan, NSW 2308, Australia
- GP Synergy, NSW & ACT Research and Evaluation Unit, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304, Australia
| | - Parker Magin
- The University of Newcastle, School of Medicine and Public Health, University Dr, Callaghan, NSW 2308, Australia
- GP Synergy, NSW & ACT Research and Evaluation Unit, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304, Australia
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Davey A, Tapley A, van Driel M, Holliday E, Fielding A, Ball J, Mulquiney K, Fisher K, Spike N, Clarke L, Moad D, Ralston A, Patsan I, Mundy B, Turner A, Tait J, Tuccitto L, Roberts S, Magin P. The Registrar Clinical Encounters in Training (ReCEnT) cohort study: updated protocol. BMC PRIMARY CARE 2022; 23:328. [PMID: 36527002 PMCID: PMC9755776 DOI: 10.1186/s12875-022-01920-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/20/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND During vocational general practice training, the content of each trainee's (in Australia, registrars') in-consultation clinical experience is expected to entail a breadth of conditions that exemplify general practice, enabling registrars to gain competency in managing common clinical conditions and common clinical scenarios. Prior to the Registrar Clinical Encounters in Training (ReCEnT) project there was little research into the content of registrars' consultations despite its importance to quality of training. ReCEnT aims to document the consultation-based clinical and educational experiences of individual Australian registrars. METHODS ReCEnT is an inception cohort study. It is comprised of closely interrelated research and educational components. Registrars are recruited by participating general practice regional training organisations. They provide demographic information about themselves, their skills, and their previous training. In each of three 6-month long general practice training terms they provide data about the practice where they work and collect data from 60 consecutive patient encounters using an online portal. Analysis of data uses standard techniques including linear and logistic regression modelling. The ReCEnT project has approval from the University of Newcastle Human Research Ethics Committee, Reference H-2009-0323. DISCUSSION Strengths of the study are the granular detail of clinical practice relating to patient demographics, presenting problems/diagnoses, medication decisions, investigations requested, referrals made, procedures undertaken, follow-up arranged, learning goals generated, and in-consultation help sought; the linking of the above variables to the presenting problems/diagnoses to which they pertain; and a very high response rate. The study is limited by not having information regarding severity of illness, medical history of the patient, full medication regimens, or patient compliance to clinical decisions made at the consultation. Data is analysed using standard techniques to answer research questions that can be categorised as: mapping analyses of clinical exposure; exploratory analyses of associations of clinical exposure; mapping and exploratory analyses of educational actions; mapping and exploratory analyses of other outcomes; longitudinal 'within-registrar' analyses; longitudinal 'within-program' analyses; testing efficacy of educational interventions; and analyses of ReCEnT data together with data from other sources. The study enables identification of training needs and translation of subsequent evidence-based educational innovations into specialist training of general practitioners.
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Affiliation(s)
- Andrew Davey
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, NSW 2308 Australia ,NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304 Australia
| | - Amanda Tapley
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, NSW 2308 Australia ,NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304 Australia
| | - Mieke van Driel
- grid.1003.20000 0000 9320 7537Faculty of Medicine, General Practice Clinical Unit, The University of Queensland, 288 Herston Road, Brisbane, QLD 4006 Australia
| | - Elizabeth Holliday
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, NSW 2308 Australia
| | - Alison Fielding
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, NSW 2308 Australia ,NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304 Australia
| | - Jean Ball
- grid.413648.cClinical Research Design and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Katie Mulquiney
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, NSW 2308 Australia ,NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304 Australia
| | - Katie Fisher
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, NSW 2308 Australia ,NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304 Australia
| | - Neil Spike
- Eastern Victoria General Practice Training (EVGPT), 15 Cato Street, Hawthorn, VIC 3122 Australia ,grid.1008.90000 0001 2179 088XDepartment of General Practice and Primary Health Care, University of Melbourne, 200 Berkeley Street, Carlton, VIC 3053 Australia ,grid.1002.30000 0004 1936 7857Faculty of Medicine, Nursing and Health Sciences, School of Rural Health, Monash University, Churchill, VIC 3842 Australia
| | - Lisa Clarke
- General Practice Training Tasmania (GPTT), Level 3, RACT House, 179 Murray Street, Hobart, TAS 7000 Australia
| | - Dominica Moad
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, NSW 2308 Australia ,NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304 Australia
| | - Anna Ralston
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, NSW 2308 Australia ,NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304 Australia
| | - Irena Patsan
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, NSW 2308 Australia ,NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304 Australia
| | - Benjamin Mundy
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, NSW 2308 Australia ,NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304 Australia
| | - Alexandria Turner
- NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304 Australia ,grid.1003.20000 0000 9320 7537Faculty of Medicine, General Practice Clinical Unit, The University of Queensland, 288 Herston Road, Brisbane, QLD 4006 Australia
| | - Jordan Tait
- NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304 Australia
| | - Lucrezia Tuccitto
- Eastern Victoria General Practice Training (EVGPT), 15 Cato Street, Hawthorn, VIC 3122 Australia
| | - Sarah Roberts
- General Practice Training Tasmania (GPTT), Level 3, RACT House, 179 Murray Street, Hobart, TAS 7000 Australia
| | - Parker Magin
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, NSW 2308 Australia ,NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Dr, Mayfield West, NSW 2304 Australia
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Baillie EJ, Merlo G, Magin P, Tapley A, Mulquiney KJ, Davis JS, Fielding A, Davey A, Holliday E, Ball J, Spike N, FitzGerald K, van Driel ML. Antibiotic prescribing for upper respiratory tract infections and acute bronchitis: a longitudinal analysis of general practitioner trainees. Fam Pract 2022; 39:1063-1069. [PMID: 35640041 PMCID: PMC9680663 DOI: 10.1093/fampra/cmac052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Most antibiotic prescribing for upper respiratory tract infections (URTIs) and acute bronchitis is inappropriate. Substantive and sustained reductions in prescribing are needed to reduce antibiotic resistance. Prescribing habits develop early in clinicians' careers. Hence, general practice (GP) trainees are an important group to target. OBJECTIVES We aimed to establish temporal trends in antibiotic prescribing for URTIs and acute bronchitis/bronchiolitis by Australian GP trainees (registrars). METHODS A longitudinal analysis, 2010-2019, of the Registrars Clinical Encounters in Training (ReCEnT) dataset. In ReCEnT, registrars record clinical and educational content of 60 consecutive consultations, on 3 occasions, 6 monthly. Analyses were of new diagnoses of URTI and acute bronchitis/bronchiolitis, with the outcome variable a systemic antibiotic being prescribed. The independent variable of interest was year of prescribing (modelled as a continuous variable). RESULTS 28,372 diagnoses of URTI and 5,289 diagnoses of acute bronchitis/bronchiolitis were recorded by 2,839 registrars. Antibiotic prescribing for URTI decreased from 24% in 2010 to 12% in 2019. Prescribing for acute bronchitis/bronchiolitis decreased from 84% to 72%. "Year" was significantly, negatively associated with antibiotic prescribing for both URTI (odds ratio [OR] 0.90; 95% confidence interval [CI]: 0.88-0.93) and acute bronchitis/bronchiolitis (OR 0.92; 95% CI: 0.88-0.96) on multivariable analysis, with estimates representing the mean annual change. CONCLUSIONS GP registrars' prescribing for URTI and acute bronchitis/bronchiolitis declined over the 10-year period. Prescribing for acute bronchitis/bronchiolitis, however, remains higher than recommended benchmarks. Continued education and programme-level antibiotic stewardship interventions are required to further reduce registrars' antibiotic prescribing for acute bronchitis/bronchiolitis to appropriate levels.
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Affiliation(s)
- Emma J Baillie
- General Practice Clinical Unit, The University of Queensland, Brisbane, QLD 4006, Australia
| | - Gregory Merlo
- General Practice Clinical Unit, The University of Queensland, Brisbane, QLD 4006, Australia
| | - Parker Magin
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,GP Synergy NSW & ACT Research and Evaluation Unit, Newcastle, NSW, Australia
| | - Amanda Tapley
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,GP Synergy NSW & ACT Research and Evaluation Unit, Newcastle, NSW, Australia
| | - Katie J Mulquiney
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,GP Synergy NSW & ACT Research and Evaluation Unit, Newcastle, NSW, Australia
| | - Joshua S Davis
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Alison Fielding
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,GP Synergy NSW & ACT Research and Evaluation Unit, Newcastle, NSW, Australia
| | - Andrew Davey
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,GP Synergy NSW & ACT Research and Evaluation Unit, Newcastle, NSW, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Jean Ball
- Hunter Medical Research Institute, Clinical Research Design and Statistical Support Unit (CReDITSS), New Lambton Heights, NSW 2305, Australia
| | - Neil Spike
- Eastern Victoria General Practice Training, Regional Training Organisation, Hawthorn, VIC 3122, Australia.,University of Melbourne, Department of General Practice and Primary Health Care, Berkeley Street, Carlton, VIC 3053, Australia.,Monash University, School of Rural Health, Wellington Road, Clayton, VIC 3800, Australia
| | - Kristen FitzGerald
- University of Tasmania, Tasmanian School of Medicine, Hobart, TAS 7000, Australia.,General Practice Training Tasmania, Regional Training Organisation, Hobart, TAS 7000, Australia
| | - Mieke L van Driel
- General Practice Clinical Unit, The University of Queensland, Brisbane, QLD 4006, Australia
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Wurf G, O’Neal P. Community‐based
counselling for benzodiazepine withdrawal: A mixed‐methods study of client outcomes. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Gerald Wurf
- School of Educational Psychology and Counselling Monash University Melbourne Victoria Australia
| | - Paul O’Neal
- School of Educational Psychology and Counselling Monash University Melbourne Victoria Australia
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Wurf G, Swing A. Interventions for benzodiazepine withdrawal: Perceptions of benzodiazepine counsellors. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Trends in the prescription of drugs used for insomnia: an open-cohort study in Australian general practice, 2011-2018. Br J Gen Pract 2021; 71:e877-e886. [PMID: 33950853 PMCID: PMC8366783 DOI: 10.3399/bjgp.2021.0054] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/19/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite an increase in the prevalence of sleep problems, few studies have investigated changes in the prescribing of drugs that are often used to manage insomnia. AIM To explore changes in the pattern of benzodiazepine (BZD), Z-drug (zolpidem, zopiclone), and non-BZD prescriptions. DESIGN AND SETTING Open-cohort study comprising 1 773 525 patients (55 903 294 consultations) who attended one of 404 Australian general practices at least three times in two consecutive years between 2011 and 2018. METHOD Data were extracted from MedicineInsight, a database of 662 general practices in Australia. Prescription rates per 1000 consultations, the proportion of repeat prescriptions above recommendations, and the proportion of prescriptions for patients with a recent (within 2 years) recorded diagnosis of insomnia were analysed using adjusted regression models. RESULTS Rates of BZD, Z-drug, and non-BZD prescriptions were 56.6, 4.4, and 15.5 per 1000 consultations in 2011 and 41.8, 3.5, and 21.5 per 1000 consultations in 2018, respectively. Over the whole study period, temazepam represented 25.3% of the prescriptions and diazepam 21.9%. All BZD and zolpidem prescriptions declined over the whole study period (annual change varying from -1.4% to -10.8%), but non-BZD and zopiclone prescriptions increased in the same period (annual change 5.0% to 22.6%). Repeat prescriptions that exceeded recommended levels remained at <10% for all medications, except melatonin (64.5%), zolpidem (63.3%), zopiclone (31.4%), and alprazolam (13.3%). In 2018, >50% of Z-drug and melatonin prescriptions were for patients with insomnia. There was an annual increase of 0.8-5.9% in the proportion of prescriptions associated with a recently recorded diagnosis of insomnia. CONCLUSION Overall, BZD prescriptions in Australia declined between 2011 and 2018. However, the prescription of some of these drugs increased for patients with a recently recorded diagnosis of insomnia. This is concerning because of the potential adverse effects of these medications and the risk of dependence.
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Sweetman A, Putland S, Lack L, McEvoy RD, Adams R, Grunstein R, Stocks N, Kaambwa B, Van Ryswyk E, Gordon C, Vakulin A, Lovato N. The effect of cognitive behavioural therapy for insomnia on sedative-hypnotic use: A narrative review. Sleep Med Rev 2020; 56:101404. [PMID: 33370637 DOI: 10.1016/j.smrv.2020.101404] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/12/2020] [Accepted: 07/26/2020] [Indexed: 01/09/2023]
Abstract
Although cognitive behavioural therapy for insomnia (CBTi) is the recommended 'first-line' treatment for insomnia, most patients are initially treated with sedative-hypnotic medications. Given the risk of impaired cognitive and psychomotor performance, serious adverse events, and long-term dependence associated with sedative-hypnotics, guidelines recommend that prescriptions should be limited to short-term use and that patients are provided with support for withdrawal where possible. CBTi is an effective insomnia treatment in the presence of sedative-hypnotic use. Furthermore, guidelines recommended that CBTi techniques are utilised to facilitate withdrawal from sedative-hypnotics. However, there is very little research evaluating the effect of CBTi on reduced medication use. The current narrative review integrates 95 studies including over 10,000 participants, investigating the effect of CBTi on reduced sedative-hypnotic use in different populations (e.g., hypnotic-dependent patients, older adults, military personnel), settings (e.g., primary care settings, psychiatric inpatients), CBTi modalities (e.g., self-administered reading/audio materials, digital, and therapist-administered), and in combination with gradual dose reduction programs. Based on this research, we discuss the theoretical mechanistic effects of CBTi in facilitating reduced sedative-hypnotic use, provide clear recommendations for future research, and offer pragmatic clinical suggestions to increase access to CBTi to reduce dependence on sedative-hypnotics as the 'default' treatment for insomnia.
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Affiliation(s)
- Alexander Sweetman
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia.
| | | | - Leon Lack
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - R Doug McEvoy
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Robert Adams
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, University of Adelaide, Woodville, South Australia, Australia; Respiratory and Sleep Service, Southern Adelaide Local Health Network, Bedford Park, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Ron Grunstein
- Sleep and Chronobiology Research Group, Woolcock Institute of Medical Research, University of Sydney, New South Wales, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Billingsley Kaambwa
- Health Economics, College of Medicine and Public Health, Bedford Park, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Emer Van Ryswyk
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Christopher Gordon
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Sleep and Chronobiology Research Group, Woolcock Institute of Medical Research, University of Sydney, New South Wales, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Andrew Vakulin
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Nicole Lovato
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
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