Hypnotic prescription without face to face contact: A report from French family medicine

Abstract

Background: Guidelines suggest a review of hypnotic prescriptions every four weeks for zopiclone, zolpidem and zaleplon (‘Z-drugs’). The lack of face-to-face consultation between the physician and the patient increases the potential of misuse and resultant dependence.

Objectives: To determine the proportion of long-term hypnotic Z-drug prescription issued without face-to-face consultation, and factors associated with such practice.

Method: Audit based on an extract of data from the French health insurance database in two French departments. Long-term Z-drug prescriptions by general practitioners (GPs) were analysed over a one-year period, regardless of the association of the prescription with a reimbursed consultation. Main factors considered were patient characteristics (gender, age, socioeconomic status, suffering from a chronic disease) and physician characteristics (gender, age, location of the practice, patient list size).

Results: Overall, 67 256 long-term Z-drug prescriptions were reviewed. Of these, 23 107 (34.4%) were not associated with a consultation. Only 17% (95%CI: 16–18%) of long-term hypnotic consumers attended a consultation on all the dates noted on the prescription. Z-drug prescriptions were more likely to be prescribed in a consultation if the patient had a chronic illness (P < 0.0001), a low socioeconomic status (P < 0.0001), was less than 45 or over 65 years old (P < 0.0001), or visited a psychiatrist during the same year (P < 0.0001). Having a longer patient list or practising in a rural area were physician characteristics associated with non-adherent Z-drug prescription (P < 0.0001).

Conclusion: Prescribing Z-drug hypnotics without a face-to-face consultation was frequent, especially in middle-aged patients without co-morbidity who were not seen by a psychiatrist.

Keywords::

• hypnotics and sedatives
• sleep initiation and maintenance disorders
• drug prescriptions
• guideline adherence
• family practice

ACKNOWLEDGEMENTS

The authors wish to thank the employees of the Service Médical Régional de l’Assurance Maladie, who were involved in data extraction from the SIAM system, and two General Practitioners who participated in the review of the manuscript: L. Brutus (Institut de Recherche pour le Développement, Paris) and K. Pal (University College of London).

Declaration of interest: The authors report no conflict of interest.