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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.
GPs 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.
Key Points
Ethical approval
The Rx-PAD study was approved by the Regional Committee for Research Ethics (REK 2009/439/REK SØR ØST A) and by the Norwegian Social Science Data Services (NSD) [1) 05/01171-2/FBB, and 2) 12731 GEH/RH]. This included acceptance to extract the GPs’ consultations and prescriptions data. The Norwegian Directorate for Health and Social Affairs had approved exception from health profession secrecy allowing for record linkage between GPs’ EMR-data with corresponding data from NorPD.
Acknowledgements
The study was supported by grants from The Norwegian Research Fund for General Practice (AMFF) and Gidske and Peter Jacob Sørensen Fund.
Disclosure statement
The authors report no conflict of interest. The authors take all responsibility for the content and the writing of this paper.
Additional information
Notes on contributors
Anne Cathrine Sundseth
Anne Cathrine Sundseth; GP in Oslo and a PhD D student at the Department of General Practice, Institute of Health and Society, at the University of Oslo, Norway.
Svein Gjelstad
Svein Gjelstad; Associate Professor and Researcher at the Department of General Practice, Institute of Health and Society, at the University of Oslo, Norway. Developer of the software required to perform the study.
Jorund Straand
Jorund Straand; Professor and Head of the Department of General Practice, Institute of Health and Society, at the University of Oslo, Norway. Head of the General Practice Research Unit, Institute of Health and Society, at the University of Oslo, Norway.
Elin O. Rosvold
Elin Olaug Rosvold; Professor at the Department of General Practice, Institute of Health and Society, at the University of Oslo, Norway.