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Alwhaibi M. Inappropriate Medications Use and Polypharmacy among Older Adults with Anxiety Disorder. J Clin Med 2023; 12:4195. [PMID: 37445226 DOI: 10.3390/jcm12134195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Elderly with mental health conditions usually use multiple medications, which predisposes them to inappropriate use of medications, which is defined as medications that should be avoided due to their risk; this outweighs their benefit given that safer alternatives are available. This study aimed to examine potentially inappropriate medication use among older patients with anxiety disorder. METHODS This study used a cross-sectional retrospective study design using twelve months of data extracted from the Electronic Health Record (EHR) database for older adults diagnosed with anxiety disorder and treated in the ambulatory care setting. Potentially inappropriate medications (PIMs) use was evaluated using the 2019 Beers criteria. Descriptive statistics were used to describe the sample. Pearson's chi-square tests (for categorical variables) and t-tests (for continuous variables) were utilized to measure the differences in independent variables between patients with and without PIMs. Binary logistic regression was used to examine the associations between PIMs use and identify potential factors for PIMs use among older adults with anxiety disorder. Analyses were performed using the Statistical Analysis Software version 9.4 (SAS® 9.4). RESULTS The study sample includes 371 older adults (age ≥ 65 years) with anxiety disorder; their average age was (72.1 ± 5.8) years. PIMs use was highly prevalent among older adults with anxiety (66.6%). About 35.6% of the study sample used one PIM, 22.6% used two PIMs, and 8.4% used three PIMs. The most frequently prescribed PIMs were NSAIDs and gastrointestinal agents. The adjusted regression analysis found that PIMs use was less likely among men than women. In addition, PIMs use was more likely among women with diabetes, cancer, and polypharmacy. CONCLUSIONS Future studies on strategies and interventions rationing PIMs use in older adults with anxiety disorder are necessary given the high prevalence of PIMs and polypharmacy within this population.
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Affiliation(s)
- Monira Alwhaibi
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh 11149, Saudi Arabia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11149, Saudi Arabia
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Slee A, Nazareth I, Bondaronek P, Liu Y, Cheng Z, Freemantle N. Pharmacological treatments for generalised anxiety disorder: a systematic review and network meta-analysis. Lancet 2019; 393:768-777. [PMID: 30712879 DOI: 10.1016/s0140-6736(18)31793-8] [Citation(s) in RCA: 165] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/27/2018] [Accepted: 07/27/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Generalised anxiety disorder is a disease that can be associated with substantial dysfunction. Pharmacological treatment is often the first choice for clinicians because of the cost and resource constraints of psychological alternatives, but there is a paucity of comparative information for the multiple available drug choices. METHODS A systematic review and network meta-analysis was performed on randomised trials in adult outpatients with generalised anxiety disorder identified from MEDLINE, Web of Science, Cochrane Library, ClinicalTrials.gov, Chinese National Knowledge Infrastructure (CNKI), Wanfang data, Drugs@FDA and commercial pharmaceutical registries. Placebo and active control trials were included. Data were extracted from all manuscripts and reports. Primary outcomes were efficacy (mean difference [MD] in change in Hamilton Anxiety Scale Score) and acceptability (study discontinuations for any cause). We estimated summary mean treatment differences and odds ratios using network meta-analyses with random effects. This study is registered with PROSPERO, number CRD42018087106. FINDINGS Studies were published between Jan 1, 1994 and Aug 1, 2017, in which 1992 potential studies were screened for inclusion. This analysis is based on 89 trials, which included 25 441 patients randomly assigned to 22 different active drugs or placebo. Duloxetine (MD -3·13, 95% credible interval [CrI] -4·13 to -2·13), pregabalin (MD -2·79, 95% CrI -3·69 to -1·91), venlafaxine (MD -2·69, 95% CrI -3·50 to -1·89), and escitalopram (MD -2·45, 95% CrI -3·27 to -1·63) were more efficacious than placebo with relatively good acceptability. Mirtazapine, sertraline, fluoxetine, buspirone, and agomelatine were also found to be efficacious and well tolerated but these findings were limited by small sample sizes. Quetiapine (MD -3·60 95% CrI -4·83 to -2·39) had the largest effect on HAM-A but it was poorly tolerated (odds ratio 1·44, 95% CrI 1·16-1·80) when compared with placebo. Likewise, paroxetine and benzodiazepines were effective but also poorly tolerated when compared with placebo. Risk of reporting bias was considered low, and when possible all completed studies were included to avoid publication bias. INTERPRETATION To our knowledge, this is the largest contemporary review of pharmacological agents for the treatment of generalised anxiety disorder by use of network analysis. There are several effective treatment choices for generalised anxiety disorder across classes of medication. The failure of initial pharmacological therapy might not be a reason to abandon a pharmacological treatment strategy. FUNDING No funding was received for this research.
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Affiliation(s)
- April Slee
- Department of Primary Care and Population Health, University College London, London UK
| | - Irwin Nazareth
- Department of Primary Care and Population Health, University College London, London UK
| | - Paulina Bondaronek
- Department of Primary Care and Population Health, University College London, London UK
| | - Yifeng Liu
- Department of Primary Care and Population Health, University College London, London UK
| | - Zhihang Cheng
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Nick Freemantle
- Institute for Clinical Trials, University College London, London UK.
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Latas M, Trajković G, Bonevski D, Naumovska A, Vučinić Latas D, Bukumirić Z, Starčević V. Psychiatrists' treatment preferences for generalized anxiety disorder. Hum Psychopharmacol 2018; 33. [PMID: 29266492 DOI: 10.1002/hup.2643] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/07/2017] [Accepted: 11/14/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The objective of this study is to ascertain psychiatrists' treatment preferences for generalized anxiety disorder (GAD) and compare them to the same psychiatrists' treatment preferences in the hypothetical scenario that treatment is to be administered to themselves as patients. METHODS A questionnaire was completed by 221 psychiatrists from 3 Balkan countries. They were asked to indicate their treatment preferences for patients with GAD and for themselves as patients. RESULTS A large majority of psychiatrists chose selective serotonin reuptake inhibitors/serotonin and norepinephrine reuptake inhibitors as preferred treatment option for GAD patients. Fewer psychiatrists selected benzodiazepines and pregabalin and about one third chose psychotherapy. The majority of psychiatrists chose the same treatments for their patients and for themselves, with main differences being in terms of pharmacotherapy (especially benzodiazepines) being less frequently recommended and psychotherapy being more frequently recommended as preferred treatment option for psychiatrists as patients. CONCLUSIONS Treatment preferences for GAD by psychiatrists in the 3 West Balkan countries were mostly in accordance with treatment guidelines and treatment preferences for patients and for psychiatrists as patients were mostly concordant. However, some psychiatrists were more likely to choose pharmacotherapy for patients and psychotherapy for themselves as patients. These findings have implications for education of psychiatrists and for efforts to improve treatment guidelines and mental health services.
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Affiliation(s)
- Milan Latas
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic of Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Goran Trajković
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dimitar Bonevski
- Psychiatric Hospital "Skopje", Centre for Mental Health "Centar", Skopje, Macedonia
| | - Andromahi Naumovska
- Psychiatric Hospital "Skopje", Centre for Mental Health "Centar", Skopje, Macedonia
| | - Dušanka Vučinić Latas
- Psychiatric Hospital, Clinical Centre "Dr Dragisa Misovic - Dedinje" and Department of Psychology, University Singidunum, Belgrade, Serbia
| | - Zoran Bukumirić
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladan Starčević
- Sydney Medical School - Nepean, Discipline of Psychiatry, University of Sydney, Sydney, Australia
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Conti EC, Stanley MA, Amspoker AB, Kunik ME. Sedative-Hypnotic Use Among Older Adults Participating in Anxiety Research. Int J Aging Hum Dev 2016; 85:3-17. [DOI: 10.1177/0091415016685330] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Older adults are prescribed sedative-hypnotic medications at higher rates than younger adults. These are not recommended for older adults due to risk of sedation, cognitive impairment, and falls. Severe generalized anxiety disorder (GAD) is a possibly appropriate use of these medications in older people, but little is available on use of sedative-hypnotic medications among older adults with GAD. This study examined the frequency and predictors of sedative-hypnotic medication use among older adults screening positive for anxiety. 25.88% ( n = 125) of participants reported taking sedative-hypnotics over the past 3 months; 16.36% ( n = 79) reported taking benzodiazepines, and 12.22% ( n = 59) reported taking hypnotic sleep medications. Depressive symptoms were more strongly associated with sedative-hypnotic use than insomnia or worry. Major depressive disorder and posttraumatic stress disorder, but not GAD, predicted sedative-hypnotic use. Other medications and treatments are more appropriate and efficacious for depression, anxiety, and insomnia in this population.
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Affiliation(s)
- Elizabeth C. Conti
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Melinda A. Stanley
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
- VA South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
| | - Amber B. Amspoker
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Mark E. Kunik
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
- VA South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
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Panagioti M, Stokes J, Esmail A, Coventry P, Cheraghi-Sohi S, Alam R, Bower P. Multimorbidity and Patient Safety Incidents in Primary Care: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0135947. [PMID: 26317435 PMCID: PMC4552710 DOI: 10.1371/journal.pone.0135947] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 07/29/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Multimorbidity is increasingly prevalent and represents a major challenge in primary care. Patients with multimorbidity are potentially more likely to experience safety incidents due to the complexity of their needs and frequency of their interactions with health services. However, rigorous syntheses of the link between patient safety incidents and multimorbidity are not available. This review examined the relationship between multimorbidity and patient safety incidents in primary care. METHODS We followed our published protocol (PROSPERO registration number: CRD42014007434). Medline, Embase and CINAHL were searched up to May 2015. Study design and quality were assessed. Odds ratios (OR) and 95% confidence intervals (95% CIs) were calculated for the associations between multimorbidity and two categories of patient safety outcomes: 'active patient safety incidents' (such as adverse drug events and medical complications) and 'precursors of safety incidents' (such as prescription errors, medication non-adherence, poor quality of care and diagnostic errors). Meta-analyses using random effects models were undertaken. RESULTS Eighty six relevant comparisons from 75 studies were included in the analysis. Meta-analysis demonstrated that physical-mental multimorbidity was associated with an increased risk for 'active patient safety incidents' (OR = 2.39, 95% CI = 1.40 to 3.38) and 'precursors of safety incidents' (OR = 1.69, 95% CI = 1.36 to 2.03). Physical multimorbidity was associated with an increased risk for active safety incidents (OR = 1.63, 95% CI = 1.45 to 1.80) but was not associated with precursors of safety incidents (OR = 1.02, 95% CI = 0.90 to 1.13). Statistical heterogeneity was high and the methodological quality of the studies was generally low. CONCLUSIONS The association between multimorbidity and patient safety is complex, and varies by type of multimorbidity and type of safety incident. Our analyses suggest that multimorbidity involving mental health may be a key driver of safety incidents, which has important implication for the design and targeting of interventions to improve safety. High quality studies examining the mechanisms of patient safety incidents in patients with multimorbidity are needed, with the goal of promoting effective service delivery and ameliorating threats to safety in this group of patients.
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Affiliation(s)
- Maria Panagioti
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Jonathan Stokes
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre (Greater Manchester PSTRC), Manchester Academic Health Science Centre University of Manchester, Manchester, United Kingdom
| | - Aneez Esmail
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre (Greater Manchester PSTRC), Manchester Academic Health Science Centre University of Manchester, Manchester, United Kingdom
| | - Peter Coventry
- NIHR Collaboration for Leadership in Applied Health Research and Care—Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Sudeh Cheraghi-Sohi
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre (Greater Manchester PSTRC), Manchester Academic Health Science Centre University of Manchester, Manchester, United Kingdom
| | - Rahul Alam
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre (Greater Manchester PSTRC), Manchester Academic Health Science Centre University of Manchester, Manchester, United Kingdom
| | - Peter Bower
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre (Greater Manchester PSTRC), Manchester Academic Health Science Centre University of Manchester, Manchester, United Kingdom
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Drobizhev MI, Fedotova AV, Kikta SV. [Rationale for the choice of medication based on the conception of the pathogenesis of mental disorder and mechanism of drug action]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 114:15-21. [PMID: 25591649 DOI: 10.17116/jnevro201411411215-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In modern medicine, when prescribing drugs it is customary to take into account the pathogenesis of the disease and the mechanism of action of drugs. On the example of buspirone, authors have shown that in psychiatry recommendations for administration of drugs should also consider the pathogenesis of diseases (disorders) and the mechanism of drug action. These data will contribute to the rapprochement of neurology and psychiatry with other medical specialties.
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Affiliation(s)
- M Iu Drobizhev
- NOKTs "Zdorovoe serdtse" GBOU VPO "Pervyĭ Moskovskiĭ gosudarstvennyĭ meditsinskiĭ universitet im. I.M. Sechenova", Moskva
| | - A V Fedotova
- Kafedra nevrologii i épileptologii FUV "Rossiĭskiĭ natsional'nyĭ issledovatel'skiĭ meditsinskiĭ universitet im. N.I. Pirogova", Moskva
| | - S V Kikta
- FGBU "Poliklinika #3" Upravleniia delami Prezidenta RF, Moskva
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Hefner G, Stieffenhofer V, Gabriel S, Palmer G, Müller KM, Röschke J, Hiemke C. Side effects related to potentially inappropriate medications in elderly psychiatric patients under everyday pharmacotherapy. Eur J Clin Pharmacol 2014; 71:165-72. [PMID: 25529227 DOI: 10.1007/s00228-014-1796-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 12/15/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Potentially inappropriate medication (PIM) is suggested to give rise to adverse drug events. To study this suggestion for elderly psychiatric patients, an observational analysis related prescription of PRISCUS PIMs and drug-induced side effects in old aged (≥65 years) psychiatric inpatients and outpatients under conditions of everyday pharmacotherapy. METHODS Request forms from a therapeutic drug monitoring (TDM) survey and medical files were screened for medication to identify PIMs of the PRISCUS list and assessed using the Udvalg for Kliniske Undersøgelser (UKU) side effect rating scale. RESULTS From 914 TDM request forms, data were available for 168 patients (64.3 % female). Patients (mean ± SD age 73.0 ± 5.5 years) received by mean 6.4 ± 3.9 drugs per day. More than half of them (53.0 %, n = 89) had at least one PIM, inpatients 0.9 ± 0.8 and outpatients 0.5 ± 0.7. Predominant PIMs were hypnotic drugs (69 %) in inpatients and antipsychotic drugs (35.6 %) in outpatients. The number of PIMs correlated with the total number of drugs administered per day (Spearman correlation coefficient 0.225, p < 0.01, CI 95 %). Side effects were documented for 106 patients (63 %). Severity of side effects did not correlate significantly (p > 0.05) with number of PIMs. However, only 6 of 77 patients who took no PRISCUS PIMs but 2 of 3 patients who took 3 PRISCUS PIMs exhibited severe side effects. CONCLUSIONS Though the prevalence for PIMs and side effects was high in old aged psychiatric inpatients and outpatients, PIMs could not be identified as major determinants of overall unwanted side effects. Nevertheless, prescription of PIMs should be minimized, especially of hypnotic drugs, to improve safety.
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Affiliation(s)
- Gudrun Hefner
- Department of Psychiatry and Psychotherapy, University Medical Center, Mainz, Germany,
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Pregabalin: a guide to its use in fibromyalgia, neuropathic pain and generalized anxiety disorder. DRUGS & THERAPY PERSPECTIVES 2014. [DOI: 10.1007/s40267-014-0107-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Baldwin DS, Rafiq R, Talat B. Overcoming barriers in the pharmacological treatment of anxiety disorders. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/npy.12.73] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Baldwin DS, Allgulander C, Bandelow B, Ferre F, Pallanti S. An international survey of reported prescribing practice in the treatment of patients with generalised anxiety disorder. World J Biol Psychiatry 2012; 13:510-6. [PMID: 22059936 DOI: 10.3109/15622975.2011.624548] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To gain insight into the experience and practice of psychiatrists in the pharmacological management of patients with generalized anxiety disorder (GAD). METHODS Multiple-choice questionnaire completed by 501 psychiatrists (representing a 45% response rate) from 18 countries, selected by pharmaceutical company representatives to attend a scientific meeting, through having an interest in anxiety disorders. RESULTS Use of screening tools, routine structured diagnostic interviews, and practice guidelines was infrequent. Over one-third of patients did not receive their initial psychiatric consultation within a month after referral. A total of 45% of patients had symptoms for 2 years or longer before being diagnosed and treated. Most patients had been treated with benzodiazepines before referral. 80% of respondents always or often prescribed selective serotonin reuptake inhibitors (SSRIs), 43% serotonin-norepinephrine reuptake inhibitors (SNRIs), or pregabalin (35%) as first-line treatments. The most frequently recommended second-line treatments were SNRIs (41%) and pregabalin (36%). Concentration difficulties, fatigue, excessive worrying and pain were reported as the symptoms most difficult to manage. CONCLUSIONS Patients with GAD have frequently been treated with benzodiazepines before referral to a psychiatrist. SSRIs were the preferred first-line treatment, and SNRIs and pregabalin preferred second-line treatments. Reported practice in this sample appears largely consistent with recent evidence-based treatment guidelines.
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Affiliation(s)
- David S Baldwin
- University of Southampton Faculty of Medicine, Southampton, UK.
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Amann U, Schmedt N, Garbe E. Prescribing of potentially inappropriate medications for the elderly: an analysis based on the PRISCUS list. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:69-75. [PMID: 22368709 PMCID: PMC3285281 DOI: 10.3238/arztebl.2012.0069] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 08/18/2011] [Indexed: 12/29/2022]
Abstract
BACKGROUND The PRISCUS list of potentially inappropriate medications (PIM) for the elderly was published in 2010 and is the first systematically constructed list of this type in Germany. The aim of the present study is to estimate the baseline prevalence of the prescribing of PIM, as defined by the PRISCUS list. METHODS Pseudonymized claims data from three statutory health insurances in Germany, which together covered more than 8 million insurants, for the year 2007 were used to determine the age- and sex-standardized one-year period prevalence of PIM among the elderly, as well as the frequency of PIM prescribing per person. The study population included all insurants who were at least 65 years old and were continuously insured throughout the year 2007 or died during that year. RESULTS Of the 804 400 elderly persons in the study population, 201 472 (25.0%) received at least one PIM prescription in 2007. The PIM prevalence was higher in women than in men (32.0% vs. 23.3%) and increased with age. The most commonly prescribed PIM were amitriptyline (2.6%), acetyldigoxin (2.4%), tetrazepam (2.0%), and oxazepam (2.0%). 8.8% of all elderly persons received the same PIM drug four or more times in 2007. CONCLUSION These data show that PIM were frequently prescribed to elderly persons in Germany before the PRISCUS list was published. Medications on the PRISCUS list are not necessarily absolutely contraindicated, and this study contained no information about the individual risk/benefit analyses that may have been carried out before these drugs were prescribed; thus, no conclusion can be drawn about the prevalence of inappropriate prescribing. Further research is needed to validate the PRISCUS list, which was generated by expert consensus, as a basis for therapeutic guidelines in geriatric medicine.
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Affiliation(s)
- Ute Amann
- Bremer Institut für Präventionsforschung und Sozialmedizin (BIPS), Universität Bremen
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Rosman S, Marc LV, Nathalie PF. Gaining insight into benzodiazepine prescribing in General Practice in France: a data-based study. BMC FAMILY PRACTICE 2011; 12:28. [PMID: 21569338 PMCID: PMC3107790 DOI: 10.1186/1471-2296-12-28] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 05/11/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND In recent decades, benzodiazepine (BZD) prescriptions have been called into question in most European countries by physicians and health authorities alike, and guidelines on medical indications and treatment duration have been established to avoid long-term use and dependency. In France, many public policy measures have been implemented as BZDs are among the most prescribed medications. General practitioners (GPs) were identified by the Caisse d'Assurance Maladie (the French public health insurance fund) as high prescribers for these drugs. In this context, the aim of the study was to determine GPs' rates and to identify correlates of BZD and Z-drugs prescribing. METHODS Data on patient characteristics, diagnoses and BZD prescriptions were drawn from French GPs' electronic medical records. These were accessed via the database which the Société Française de Médecine Générale, the French Society of General Practice, has been compiling since 1993 in a network of 90 GPs working mainly in solo practices. The participants in this network routinely register data in their daily practice. The present study examined 51,216 patients from 52 GP practices and we performed a multivariate logistic regression. The dependent variable was whether a patient was prescribed BZD at least once during 2006. RESULTS In the present study, 12.5% of patients older than 18 were prescribed BZDs at least once during 2006 and the average (SD) was 2.6 (2.4) BZD prescriptions/patient/year. The adjusted odds (confidence interval) of having at least one BZD prescription were 1.20 (1.10 - 1.30) in patients older than 65; 1.05 (1.01 - 1.10) in women; 1.25 (1.17 - 1.33) in patients with associated comorbidities (cardiovascular diseases) and 1.76 (1.62 - 1.92) in heavy consumers of health care (more than 4 consultations with a GP per year). CONCLUSIONS The present study showed the persistence of high rates of BZD prescription by GPs, particularly in women and older patients, which highlights the difficulties of implementing effective public policies and the necessity of using new approaches enabling doctors and patients to understand the true relative advantages, disadvantages, and consequences of using these drugs and of non-pharmaceutical treatments.
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Affiliation(s)
- Sophia Rosman
- INSERM U988, CNRS, UMR 8211, 7 rue Guy Moquet, 94801 Villejuif Cedex, France
- EHESS, 54 bd Raspail, 75006 Paris, France
- Université Paris-Descartes, 45 rue des Saints-Pères, 75270 Paris cedex 06, France
| | - Le Vaillant Marc
- INSERM U988, CNRS, UMR 8211, 7 rue Guy Moquet, 94801 Villejuif Cedex, France
- EHESS, 54 bd Raspail, 75006 Paris, France
- Université Paris-Descartes, 45 rue des Saints-Pères, 75270 Paris cedex 06, France
| | - Pelletier-Fleury Nathalie
- INSERM U988, CNRS, UMR 8211, 7 rue Guy Moquet, 94801 Villejuif Cedex, France
- EHESS, 54 bd Raspail, 75006 Paris, France
- Université Paris-Descartes, 45 rue des Saints-Pères, 75270 Paris cedex 06, France
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