General practitioners' prescribing patterns of benzodiazepine hypnotics: Are elderly patients at particular risk for overprescribing?

Abstract

Objective - To compare general practitioners' (GPs) prescribing patterns of benzodiazepine hypnotics with current recommendations.

Design - Observational, cross-sectional study.

Setting - The Norwegian county Møre and Romsdal.

Subjects - 3452 prescriptions for benzodiazepine hypnotics prescribed by GPs for patients aged 20 years and older during two months.

Main outcome measures - Prescriptions (strength of tablets, amount prescribed given in Defined and Prescribed Daily Doses: DDDs and PDDs, directions for use); initial or repeat, patients (age, sex); kind of GP-patient contact daring prescribing.

Results - 68.4% of the prescriptions for benzodiazepine hypnotics were for women; 52.7% were for patients aged 65 or older (65+); 59.9% were issued during indirect contacts; 81.9% were repeat prescriptions. The amount of drug per prescription increased with patients' age: 65+ received on average 69.9 DDDs (76.9 PDDs) per prescription compared with 34.4 DDDs (37.1 PDDS) for young adults (20-29 years).

About four of five presciptions were for the “strong” (i.e. 1 tablet = 1 DDD) sleeping pills irrespective of patients' age and type of prescription (initial or repeat).

Written directions for use were: “to be taken daily” in 55.1%, and “only if required” in 38.0% of the prescriptions. Written information on duration of “cure” was only found in one case.

Conclusions - GPs' prescribing patterns are not in accordance with recommended dosage and duration of treatment; this pattern is most pronounced for elderly patients.

Key Words:

• hypnotics
• elderly
• general practice
• prescribing
• drug utilization