Abstract
Objective: To describe Norwegian general practitioners’ (GPs’) prescription patterns of benzodiazepines, Z-hypnotics and opioid analgesics (BZO-drugs) to elderly (≥70 years) patients.Design, subjects and setting: Cross sectional, observational study. Contact- and prescription data from 148 Norwegian GPs, issued for elderly patients during eight months in 2008. GP-patient contacts were categorized as direct contacts (DC: face-to-face consultations) or indirect contacts (IC: via third party, phone or mail). Explanatory variables were characteristics linked to the GPs, patients, and practices. During analyses, GPs’ number of listed patients, share of which for elderly patients, and total number of patient consultations during the period (proxy for practice activity), were categorized in quintiles (Q1–5) by number of GPs.Main outcome measures: Number of BZO-drug prescriptions and quantities issued during direct- and indirect GP-patient contacts.Results: In total, 62% of BZO-prescriptions were issued during ICs. Of all prescriptions, 66% were large quantum packages (50 tablets or more), 62% out of which were prescribed during ICs. During the study period, 50% of the patients received repeat prescriptions. Prescribing during ICs was associated with low over all practice activity (Q1) and many (Q5) older patients on the GP’s lists.Conclusion: GPs’ BZO-drug prescribing to elderly occur more frequently during ICs than within DCs, and are more commonly issued as large quantity packages. This indicates that regular- or long-term use among elderly is common, contrasting with previous and current national guidelines, which recommend regular clinical assessments and short time or intermittent use of BZO-drugs.Key PointsGPs frequently prescribe benzodiazepines, Z-hypnotics and opioid (BZO) drugs for elderly people.BZO-drugs are frequently issued during indirect GP-patient contacts and in relatively large quantities, indicating regular or long-term use.GPs’ BZO-drug prescribing patterns contrast with national guidelines recommending clinical assessment and short time or intermittent use of BZO-drugs.
Highlights
Chronic pain, anxiety and sleep disturbances are all frequent health problems among elderly patients, contributing to reduced quality of life
The aim of our study is to describe Norwegian general practitioners’ (GPs)’ prescription patterns of benzodiazepines, Z-hypnotics and opioid analgesics to elderly patients in terms of drug type and amount prescribed, with emphasis on GP-patient prescription contacts, and to explore variables associated with prescribing during indirect contacts
Six out of ten of the BZO-prescriptions were issued without the GP seeing the patient, i.e. during indirect contacts (IC)
Summary
Anxiety and sleep disturbances are all frequent health problems among elderly patients, contributing to reduced quality of life. To relieve these ailments, benzodiazepines, Z-hypnotics and opioid analgesics (BZO-drugs) are commonly prescribed. According to previous and present national guidelines, opioid analgesics should be prescribed with caution, and benzodiazepines and Z-hypnotics should be prescribed at lowest effect-giving doses for short periods or intermittent use [1,2,3]. Adverse drug effects and reduced therapeutic benefits from regular, long-term use of benzodiazepines and Z-hypnotics are well established [4]. The risk increases considerably for elderly people, resulting in many drug-related falls [5,6] and enhanced risk of cognitive decline and dementia
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