Erschienen in:
23.07.2018 | Original Research
Changes in Australian Early-Career General Practitioners’ Benzodiazepine Prescribing: a Longitudinal Analysis
verfasst von:
Parker Magin, PhD, FRACGP, Amanda Tapley, MMedStats, Adrian J Dunlop, PhD, FAChAM, Andrew Davey, MClinEpid, FRACGP, Mieke van Driel, PhD, FRACGP, Elizabeth Holliday, PhD, Simon Morgan, MPH, FRACGP, Kim Henderson, GDipMedSc(HSocSc), Jean Ball, GDipMedStats, Nigel Catzikiris, BHlth, Katie Mulquiney, BND(Hons), Neil Spike, FRACGP, Rohan Kerr, FRACGP, Simon Holliday, FAChAM
Erschienen in:
Journal of General Internal Medicine
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Ausgabe 10/2018
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Abstract
Background
Australian and international guidelines recommend benzodiazepines and related drugs (hereafter “benzodiazepines”) as second-line, short-term medications only. Most benzodiazepines are prescribed by general practitioners (GPs; family physicians). Australian GP registrars (“trainees” or “residents” participating in a post-hospital training, apprenticeship-like, practice-based vocational training program), like senior GPs, prescribe benzodiazepines at high rates. Education within a training program, and experience in general practice, would be expected to reduce benzodiazepine prescribing.
Objective
To establish if registrars’ prescribing of benzodiazepines decreases with time within a GP training program
Design
Longitudinal analysis from the Registrar Clinical Encounters in Training multi-site cohort study
Participants
Registrars of five of Australia’s 17 Regional Training Providers. Analyses were restricted to patients ≥ 16 years.
Main Measures
The main outcome factor was prescription of a benzodiazepine. Conditional logistic regression was used, with registrar included as a fixed effect, to assess within-registrar changes in benzodiazepine-prescribing rates. The “time” predictor variable was “training term” (6-month duration Terms 1–4). To contextualize these “within-registrar” changes, a mixed effects logistic regression model was used, including a random effect for registrar, to assess within-program changes in benzodiazepine-prescribing rates over time. The “time” predictor variable was “year” (2010–2015).
Key Results
Over 12 terms of data collection, 2010–2015, 1161 registrars (response rate 96%) provided data on 136,809 face-to-face office-based consultations. Two thousand six hundred thirty-two benzodiazepines were prescribed (for 1.2% of all problems managed). In the multivariable model, there was a significant reduction in within-program benzodiazepine prescribing over time (year) (p = < 0.001, OR = 0.94, CI = 0.90, 0.97). However, there was no significant change in ‘within-registrar’ prescribing over time (registrar Term) (p = 0.92, OR = 1.00 [95% CI = 0.94–1.06]).
Conclusions
Despite a welcome temporal trend for reductions in overall benzodiazepine prescribing from 2010 to 2015, there is still room for improvement and our findings suggest a lack of effect of specific GP vocational training program education and, thus, an opportunity for targeted education.