- Title
- Changes in Australian Early-Career General Practitioners' Benzodiazepine Prescribing: a Longitudinal Analysis
- Creator
- Magin, Parker; Tapley, Amanda; Mulquiney, Katie; Spike, Neil; Kerr, Rohan; Holliday, Simon; Dunlop, Adrian J.; Davey, Andrew; van Driel, Mieke; Holliday, Elizabeth; Morgan, Simon; Henderson, Kim; Ball, Jean; Catzikiris, Nigel
- Relation
- Journal of General Internal Medicine Vol. 33, Issue 10, p. 1676-1684
- Publisher Link
- http://dx.doi.org/10.1007/s11606-018-4577-5
- Publisher
- Springer
- Resource Type
- journal article
- Date
- 2018
- Description
- 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.
- Subject
- benzodiazepines; family practice; education; medical, graduate; inappropriate prescribing; deprescriptions; SDG 4; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1447202
- Identifier
- uon:43082
- Identifier
- ISSN:0884-8734
- Language
- eng
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