Parker Magin1,2, Amanda Tapley3,4, Adrian J Dunlop3,5, Andrew Davey3,4, Mieke van Driel6, Elizabeth Holliday3,7, Simon Morgan4, Kim Henderson3,4, Jean Ball7, Nigel Catzikiris3,4, Katie Mulquiney3,4, Neil Spike8,9, Rohan Kerr10, Simon Holliday3,5. 1. School of Medicine and Public Health, University of Newcastle, Callaghan, Australia. parker.magin@newcastle.edu.au. 2. GP Synergy General Practice Regional Training Organisation, Newcastle, Australia. parker.magin@newcastle.edu.au. 3. School of Medicine and Public Health, University of Newcastle, Callaghan, Australia. 4. GP Synergy General Practice Regional Training Organisation, Newcastle, Australia. 5. Drug and Alcohol Clinical Services, Hunter New England Health, Newcastle, Australia. 6. Faculty of Medicine, University of Queensland, Brisbane, Australia. 7. Hunter Medical Research Institute, Newcastle, Australia. 8. Eastern Victoria GP Training, Melbourne, Australia. 9. University of Melbourne, Melbourne, Australia. 10. General Practice Training Tasmania, Hobart, Australia.
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.
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.
Entities:
Keywords:
benzodiazepines; deprescriptions; education, medical, graduate; family practice; inappropriate prescribing
Authors: Anthea Dallas; Parker Magin; Simon Morgan; Amanda Tapley; Kim Henderson; Jean Ball; John Scott; Neil Spike; Lawrie McArthur; Mieke van Driel Journal: Fam Pract Date: 2014-10-31 Impact factor: 2.267
Authors: Catherine S Hwang; Elizabeth M Kang; Cynthia J Kornegay; Judy A Staffa; Christopher M Jones; Jana K McAninch Journal: Am J Prev Med Date: 2016-04-11 Impact factor: 5.043