General practitioners’ prescriptions of benzodiazepines, Z-hypnotics and opioid analgesics for elderly patients during direct and indirect contacts. A cross-sectional, observational study

Figures & data

Textbox 1. Variables included from GPs electronic medical records (EMRs) and from The NorwegianPrescription database (NorPD).

	From the EMR system	From the NorPD
GP and practice variables
Unique identifier	✓	✓
Year of birth	✓	✓
Gender	✓	✓
GP specialist	✓	✓
Solo/center practice	✓
City/rural practice	✓
Number of annual consultations	✓
Number of listed patients	✓
Number of listed patients age 70+	✓
Patient related variables
Unique patient identifier*	✓	✓
Year of birth	✓	✓
Gender	✓	✓
Date of GP-patient consultation	✓
Consultation type	✓
Date of prescription	✓
Date medication dispensed from pharmacy		✓
Medication ATC code	✓	✓
Medication strength	✓	✓
Medication package size	✓	✓
Medication number of packages	✓	✓

* Different in the EMR and the NorPD.

Table 1. Characteristics of included physicians (n = 148) and their practices.

	Total (n = 148)	Male GPs (n = 97)	Female GPs (n = 51)*
Age, years, Mean* [95% CI]	50 [48.3–51]	51 [49–52. 3]	48 [45.6–49.9]
Specialist GP (%)* [95% CI]	83% [0.8–0.9]	88% [0.8–0.9]	75% [0.6–0.9]
Group Practice (%) [95% CI]	93% [0.9–1.0]	93% [0.9–1.0]	92% [0.9–1.0]
Practice location
Urban (%) [95% CI]	42% [0.3–0.5]	47% [0.4–0.6]	31% [0.2–0.5]
Patient list size per GP
Mean* (Range min–max)	1384 (516–3224)	1428 (574–3224)	1301 (516–2492)
Patients ≥70 years on list
Mean (Range min–max)	150 (10.8% of list) (28–435)	169 (11.5% of list) (37–435)	113 (8.7% of list) (28–271)
Total number of consultations (8 months)
Mean (Range min–max)	2068 (144–4458)	2141 (144–4458)	1929 (558–3350)

* All Norwegian GPs, 2008: Mean age: 48,3; Female GPs: 33,7%; Specialist GPs: not available for 2008, 59% in 2004; Mean patient list size: 1190 [30].

Table 2. Prescriptions of benzodiazepines, Z-hypnotics or opioid analgesics for elderly patients during direct (DC) and indirect (IC) GP-patient contacts by physician-, practice- and patient characteristics. Quintiles (Q1–Q5) are by number of GPs.

	Number of BZO-prescriptions for patients ≥70 years	Percentage of prescriptions during ICs [95% CI]
Total Prescribers	N = 28,659	61.9% (n = 17,740) [61.3–62.5]
Male (n = 97)	20,743	61.8% [61.1–62.5]
Female (n = 51)	7916	62.1% [61.0–63.2]
Age Group
Q*1 (29–42 years)	3879	64.9% [63.3–66.4]
Q2 (43–48 years)	5239	60.9% [59.6–62.2]
Q3 (49–53 years)	6897	59.0% [57.8–60.2]
Q4 (54–56 years)	5251	67.1% [65.8–68.4]
Q5 (57–65 years)	7393	60.1% [59.0–61.2]
Practices
Single handed practice	2594	60.4% [58.5-62.3]
Group practice (92.6%)	26,065	62.1% [61.5–62.7]
Rural location (58.1%)	15,465	63.1% [62.3–63.9]
Urban location (41.9%)	13,194	60.5% [59.7–61.3]
Number of listed patients, total
Q1 (516–1081)	4123	66.8% [65.3–68.2]
Q2 (1082–1254)	6498	61.9% [60.7–63.1]
Q3 (1255–1433)	6245	60.6% [59.4–61.8]
Q4 (1434–1608)	4745	62.6% [61.2–64.0]
Q5 (1609–3224)	7048	59.7% [58.5–60.9]
Number of listed patients ≥70
Q1 (28–78)	2324	61.0% [59.0–63.0]
Q2 (79–122)	4017	62.2% [60.7–63.7]
Q3 (123–159)	5520	61.0% [59.7–62.3]
Q4 (160–212)	7033	61.9% [60.8–63.0]
Q5 (213–435)	9765	62.5% [61.5–63.5]
Total consultations (8 months)
Q1 (144–1519)	3709	70.4% [68.9–71.9]
Q2 (1520–1900)	5119	63.6% [62.3–64.9]
Q3 (1901–2211)	6102	61.4% [60.2–62.6]
Q4 (2212–2551)	5640	60.6% [59.3–61.9]
Q5 (2552–4458)	8089	58.2% [57.1–59.3]
Patients
Males (n = 2685)	7534	61.6% [60.5–62.7]
Females (n = 6682)	21,125	62.0% [61.3–62.7]
Age 70–79 years (49.2%)	14,343	58.8% [58.0–59.6]
Age ≥80 years	14,316	65.0% [64.2–65.8]

* Q denotes quintile.

Table 3. Prescriptions of benzodiazepines (bzd), Z-hypnotics or opioid analgesics for elderly patients during direct and indirect GP-patient contacts by package size issued.

	Number of prescriptions	Direct contact prescriptions (%), [95% CI]	Indirect contact prescriptions (%), [95% CI]
All prescriptions	28,659 (100%)	10,919 (38.1) [37.5–38.7]	17,740(61.9) [61.3–62.5]
Package ≥ 50 tablets (%) [95%CI]	18,946 (66.1) [65.6–66.7]	7285 (38.5) [37.8–39.1]*	11,661 (61.5) [60.9–62.2]*
Strong opioids, total	3260	888 (27.2) [25.7–28.8]	2372 (72.8) [71.2–74.3]
Package ≥ 50 tablets (%) [95% CI]	1111 (34.1) [32.5–35.7]	253 (22.8) [20.3–25.4]*	858 (77.2) [74.6–79.7]*
Weak opioids, total	7191	2969 (41.3) [40.1–42.4]	4222 (58.7) [57.6–59.9]
Package ≥ 50 tablets (%) [95% CI]	5460 (75.9) [74.9–76.9]	2220 (40.7) [39.4–42.0]*	3240 (59.3) [58.0–60.6]*
Bzd-anxiolytics, total	6993	2911 (41.6) [40.5–42.8]	4082 (58.4) [57.2–59.5]
Package ≥ 50 tablets (%) [95% CI]	5201 (74.4) [73.3–75.4]	2070 (39.8) [38.5–41.1]*	3131 (60.2) [58.9–61.5]*
Bzd-hypnotics, total	1681	663 (39.4) [37.1–41.8]	1018 (60.6) [58.2–62.9]
Package ≥ 50 tablets (%) [95% CI]	1346 (80.1) [78.1–82.0]	582 (43.2) [40.6–45.9]*	764 (56.8) [54.1–59.4]*
Z-hypnotics, total	9534	3488 (36.6) [35.6–37.6]	6046 (63.4) [62.4–64.4]
Package ≥ 50 tablets (%) [95% CI]	5828 (61.1) [60.1–62.1]	2160 (37.1) [35.8–38.3]*	3668 (62.9) [61.7–64.2]*

* Prescription share of large packages (≥ 50 tablets).

Table 4. Multilevel logistic regression analysis showing factors independently associated with prescribing benzodiazepines, Z-hypnotics and opioid analgesics for elderly patients during indirect GP-patient contacts, with GPs as the cluster Level. Dependent variable: 0 = direct contacts (n = 8346), 1 = indirect contacts (n = 14,165).

	Number of contacts N (%)	Bivariate analysis OR (95% CI)	Multivariate analysis OR (95% CI)
Prescribers
Female (n = 51)	6161 (27.4)	1 (reference)	1 (reference)
Male (n = 97)	16,350 (72.6)	1.0 (0 85–1.29)	1.01 (0.81–1.25)
Age group
Q*1 (29–42 years)	3050 (13.5)	1 (reference)	1 (reference)
Q2 (43–48 years)	4129 (18.3)	0.89 (0.65–1.22)	1.02 (0.74–1.40)
Q3 (49–53 years)	5336 (23.7)	0.87 (0.64–1.18)	0.95 (0.69–1.31)
Q4 (54–56 years)	4162 (18.5)	1.14 (0.82–1.58)	1.14 (0.82–1.57)
Q5 (57–65 years)	5834 (25.9)	0.97 (0.71–1.32)	0.96 (0.69–1.33)
Practices
Single handed practice	2031 (8.9)	1 (reference)	1 (reference)
Group Practice	20,878 (91.1)	0.89 (0.61–1.29)	0.92 (0.64–1.32)
Rural location	10,496 (45.8)	1 (reference)	1 (reference)
Urban location	12,413 (54.2)	0.91 (0.75–1.11)	0.97 (0.79–1.18)
Number of listed patients ≥70 years
Q1 (28–78)	1858 (8.1)	1 (reference)	1 (reference)
Q2 (79–122)	3240 (14.1)	1.06 (0.77–1.45)	1.02 (0.76–1.38)
Q3 (123–159)	4347 (19.0)	1.02 (0.74–1.40)	1.12 (0.80–1.55)
Q4 (160–212)	5569 (24.3)	1.16 (0.85–1.59)	1.26 (0.91–1.74)
Q5 (213–435)	7895 (34.5)	1.28 (0.93–1.75)	1.50 (1.08–2.08)
Total number of office consultations, all patient age groups (8 months)
Q1 (144–1519)	2929 (12.8)	1 (reference)	1 (reference)
Q2 (1520–1900)	3955 (17.3)	0.75 (0.55–1.02)	0.71 (0.52–0.97)
Q3 (1901–2211)	4930 (21.5)	0.70 (0.52–0.95)	0.65 (0.48–0.89)
Q4 (2212–2551)	4514 (19.7)	0.65 (0.48–0.89)	0.64 (0.47–0.88)
Q5 (2552–4458)	6581 (28.7)	0.60 (0.45–0.82)	0.54 (0.39–0.74)
Patients ≥70 years
Females	16,784 (73.3)	1 (reference)	1 (reference)
Males	6125 (26.7)	0.97 (0.91–1.03)	0.97 (0.91–1.04)
Age 70–80 years	11,361 (49.6)	1 (reference)	1 (reference)
Age ≥80 years	11,548 (50.4)	1.23 (1.16–1.30)	1.23 (1.16–1.30)

*Q denotes quintile.

Helsedirektoratet. Fastlegestatistikk - 2009. The Norwegian Directorate of Health, 2009.

 Google Scholar