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Prescription of benzodiazepines and Z-drugs among older patients in primary care: a French, national, cohort study

Jonathan Yana, Laura Moscova, Julien Le Breton, Emmanuelle Boutin, Tiphaine Siess, Pascal Clerc, Sylvie Bastuji-Garin, Emilie Ferrat

Article category: Epidemiology

Jonathan Yana a,b,  Laura Moscova a,  Julien Le Breton a,c,d,e,  Emmanuelle Boutin c,f,  Tiphaine Siess a,  Pascal Clerc d,g,  Sylvie Bastuji-Garin c,h , Emilie Ferrata b,c.

a Univ Paris-Est Creteil, School of Medicine, Primary Care Department, F-94010 Creteil, France;
b Maison de Santé pluri-professionnelle Universitaire de St-Maur des Fossés, F-94100, France
c Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
d Société France de Médecine Générale, Issy Les Moulineaux, F-92130, France
e Centre de santé universitaire Salvador Allende, F-93120 La Courneuve, France
f APHP, hopital Henri-Mondor, Unité de Recherche Clinique (URC Mondor), F-94000 Creteil, France
g Université de Versailles, School of Medicine, Primary Care Department, F-78000 Versailles, France
h APHP, hopital Henri-Mondor, Department of public health, F-94000 Creteil, France
Corresponding author: Dr. J. Yana, Maison de Santé pluri-professionnelle Universitaire

To cite this version:
Jonathan Yana, Laura Moscova, Julien Le Breton, Emmanuelle Boutin, Tiphaine Siess, et al.. Prescription of benzodiazepines and Z-drugs among older patients in primary care: a French, national, cohort study.
Family Practice, 2022, 10.1093/fampra/cmac114ff. ffhal-04157717f

ABSTRACT

Background: In France, general practitioners (GPs) prescribe benzodiazepines and Z-drugs (BZD/ZDs) widely, and especially to older adults. Several characteristics of patients and/or GPs linked to BZD/ZD overprescription have been described in the general population but not among older patients in primary care.

Objectives: To estimate the proportion of GP consultations by patients aged 65 and over that resulted in a BZD/ZD prescription, and determine whether any GP-related factors predicted BZD/ZD overprescription in this setting.
Methods: We analyzed sociodemographic and practice-related GP characteristics, and aggregated data on consultations recorded prospectively by 117 GPs in a database between 2000 and 2010. Next, we used logistic regression models to look for factors potentially associated with BZD/ZD overprescription (defined as an above-median prescription rate).

Results: The GPs’ mean age at inclusion was 47.4 (7.1), and 87.9% were male. During the study period, the median [95% confidence interval] proportion of consultations with patients aged 65 and over resulting in a BZD/ZD prescription was 21.8% [18.1-26.1] (range per GP: 5– 34.1%). In a multivariable analysis, a greater number of chronic disease (OR [95%CI] = 2.10 [1.22-3.64]), a greater number of drugs prescribed per consultation (5.29 [2.72-10.28]), and shorter study participation were independently associated with BZD/ZD overprescription.

Conclusions: BZD/ZD overprescription was associated with a greater chronic disease burden and the number of drugs prescribed per consultation but not with any sociodemographic or practice-related GP characteristics. Targeted actions are needed to help GPs limit their prescription of BZD/ZDs to older patients with multiple comorbidities and polypharmacy.

KEYWORDS

Benzodiazepines; Hypnotics and sedatives; Inappropriate prescriptions; Aged;General practice; Cohort studies