Évaluation de la prescription et de l’utilisation des benzodiazépines dans la commune de Saint-Louis du Sénégal : enquête auprès des patients

Benzodiazepine prescribing to the Swiss adult population: results from a national survey of community pharmacies

The purpose of the study was to assess prevalence of benzodiazepine use in the Swiss adult population and to assess on benzodiazepine prescription patterns of physicians in domiciliary practice.

STUDY DESIGN

A retrospective, population-based cross-sectional study with 520 000 patients covering a 6-month period.

METHODS

We estimated the prevalence, amount and duration of benzodiazepine use using a pharmacy dispensing database.

RESULTS

Of all patients, 9.1% (n=45 309) received at least one benzodiazepine prescription in the 6-month period. Most persons receiving benzodiazepine prescriptions were women (67%), and half of all patients were aged 65 or older. Of 45 309 patients with benzodiazepine prescriptions, 44% (n=19 954) had one single prescription, mostly for a short period (<90 days) and in lower than the recommended dose range. Fifty-six percent (n=25 354) had repeated benzodiazepine prescriptions, mostly for a long time period (>90 days), and in lower than the recommended or within the recommended dose range. In patients with long-term use (n=25 354), however, 1.6% had benzodiazepine prescriptions in extremely high doses. The sample of patients with repeated prescriptions allowed an estimation of a benzodiazepine use of 43.3 daily defined doses per 1000 inhabitants in Switzerland.

CONCLUSIONS

Benzodiazepine prescriptions were appropriate for most patients and thus were prescribed in therapeutic doses, as indicated in the treatment guidelines. On the other hand, our survey showed that 1.6% of the patients had prescriptions for long time periods at very high doses, indicating an abuse or dependence on benzodiazepines in this subgroup.

[Prescription of benzodiazepines by general practitioners in the private sector of Dakar: survey on knowledge and attitudes]

OBJECTIVE

The objective of this study was to evaluate knowledge and attitudes of general practitioners of the private sector, in Dakar, concerning prescription of benzodiazepines, in order to make, possibly, recommendations for their rational use.

METHOD

A survey was done in 2005 with a representative sample of 55 medical doctors. Medical doctors filled in the questionnaire which focused on the main benzodiazepines' indications, those prescribed and their rules of prescription.

RESULTS

The main indications were anxiety, convulsions, epilepsy and insomnia and the benzodiazepines prescribed in first intention were prazepam against anxiety and insomnia and diazepam against convulsions and epilepsy. Practically 17% of medical doctors ignored the existence of limited period of benzodiazepine use and 70.9% of medical doctors considered their training on benzodiazepines insufficient.

CONCLUSION

These results show the necessity to base continuous training for these general practitioners on the pharmacology of benzodiazepines.

Benzodiazepines prescription in Dakar: a study about prescribing habits and knowledge in general practitioners, neurologists and psychiatrists

Benzodiazepines are relatively well-tolerated medicines but can induce serious problems of addiction and that is why their use is regulated. However, in developing countries like Senegal, these products are used without clear indications on their prescription, their dispensation or their use. This work focuses on the prescription of these medicines with a view to make recommendations for their rational use. Benzodiazepine prescription was studied with psychiatrists or neurologists and generalists in 2003. Specialist doctors work in two Dakar university hospitals and generalists in the 11 health centres in Dakar. We did a survey by direct interview with 29 of 35 specialists and 23 of 25 generalists. All doctors were interviewed in their office. The questionnaire focused on benzodiazepine indications, their pharmacological properties, benzodiazepines prescribed in first intention against a given disease and the level of training in benzodiazepines by doctors. Comparisons between specialists and generalists were made by chi-square test. Benzodiazepines were essentially used for anxiety, insomnia and epilepsy. With these diseases, the most benzodiazepines prescribed are prazepam against anxiety and insomnia and diazepam against epilepsy. About 10% of doctors do not know that there is a limitation for the period of benzodiazepine use. The principal reasons of drugs choice are knowledge of the drugs, habit and low side effects of drugs. All generalists (100%) said that their training on benzodiazepines is poor vs. 62.1% of specialists, and doctors suggest seminars, journals adhesions and conferences to complete their training in this field. There are not many differences between specialists and generalists except the fact that specialists prefer prazepam in first intention in the insomnia treatment where generalists choose bromazepam. In addition, our survey showed that specialists' training in benzodiazepines is better than that of generalists. Overall, benzodiazepine prescription poses problems particularly in training, and national authorities must take urgent measures for rational use of these drugs.