Prescription of potentially addictive medications after a multilevel community intervention in general practice

Abstract

Objective

To evaluate the long-term effects of a multilevel community intervention to improve the quality of prescription practice of potentially addictive medications (PAMs).

Design

We conducted a retrospective study, using anonymized data from the Norwegian prescription registry.

Setting

Based on an initiative from the GPs in Molde Municipality in Norway, a multilevel community intervention was initiated by the municipal chief physician in 2018. The intervention targeted GPs, patients, and the public.

Subjects

We retrieved prescription data from 26 of 36 GPs.

Main outcome measures

By using the standardized defined daily dose (DDD), we compared prescription of three groups of PAMs from before the intervention (2017) throughout the intervention in 2018, and through 2020 to determine long-term effects.

Results

Three years after the intervention, the GPs in our study sample prescribed 26% less opioids, 38% less benzodiazepines, and 16% less z-hypnotics. Overall prescription of PAMs decreased by 27%. The number of individuals receiving at least 90 DDD of benzodiazepines and z-hypnotics were reduced from 9 to 7 and 34 to 24 per 1000, respectively. Also, the number of individuals receiving two and three PAMs concomitantly were reduced.

Conclusion

Addressing prescription practice among GPs in a community as a joint intervention, combined with addressing patients and the public may be a feasible method to obtain long-term reduction of PAM prescriptions.

Key points

• Non-therapeutic prescriptions of potentially addictive medications (PAMs) are both a public health concern and a frequent challenge in general practice.

• A multilevel community intervention, targeting general practitioners, patients, and the public, led to 27% reduction in prescription of PAMs.

• Both the number of daily users and concomitant use of several PAMs were reduced.

• The reduction in prescription persisted for three years.

Keywords:

• Opioid
• benzodiazepine
• z-hypnotic
• tapering
• inappropriate prescribing
• polypharmacy
• public health

Acknowledgement

The authors thank the GPs in Molde for providing their prescription data.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Muhunthan Navaratnam’s work on this project was supported by the General Practice Research Committee of the Norwegian Medical Association.