Benzodiazepine reduction in general practice. Are the elderly neglected?

In two Danish general practices a few simple rules applicable to all age groups were introduced in order to reduce consumption of benzodiazepines (BZ) and cyclopyrrolones (CP). These rules, termed the "Thyborøn-Model", included the termination of telephone prescriptions, the issuance of prescriptions only following personal consultation and the restriction of prescriptions to a maximum of a single month's consumption. The purpose of the present demographic analysis is to investigate whether the intervention was successful for the elderly, who are considered to be a special target group. The findings presented here reveal that the number of BZ and CP users increased with increasing age. Furthermore, the results indicate that the intervention was effective in reducing the consumption of BZ and CP for middle-aged and elderly patients, and that there is a significantly better effect of this model for middle-aged than for elderly patients. These findings constitute the first demographic evaluation of the effects of the "Thyborøn-Model" with focus on the special target group of elderly patients, and indicate that it is advisable to introduce these simple rules for all age groups, especially since they also are effective on elderly patients.

Benzodiazepine and cyclopyrrolone reduction in general practice--does this lead to concomitant change in the use of antipsychotics? A study based on a Danish population.

INTRODUCTION: In the period 2004-2006, 15 doctors in the Danish municipality of Lemvig introduced a more restrictive approach to the prescription of benzodiazepines and cyclopyrrolones. A prescription could be renewed only following personal consultation, and prescriptions were issued for only a single month's usage. The intervention reduced the prescription of benzodiazepine anxiolytics by 50%, cyclopyrrolones by 57% and benzodiazepine hypnotics by 55% over a 1(1/2) year period. There is a paucity of knowledge about whether such an intervention reduces drug consumption in general or merely shifts consumption to other drugs. Here especially antipsychotics (AP) are in the spotlight. MATERIALS AND METHODS: The current article describes the prescription of antipsychotics before and after the intervention. Consumption was followed via the Danish Medicines Agency's website Ordiprax, where the quantity of pharmacy-sold prescription drugs by individual medical practices can be monitored. RESULTS: The overall increase in the prescription of antipsychotics during the intervention described here was not more than 3.1% of the reduction in prescriptions of benzodiazepine and cyclopyrrolone measured in defined daily doses (DDD). CONCLUSION: The intervention against benzodiazepine and cyclopyrrolone did not result in an uncontrollable increase in the prescription of antipsychotic drugs. It cannot be excluded that the intervention impacted individual prescriptions. For future interventions of a similar nature, it is recommended that GPs are trained in the use of antipsychotics.

Benzodiazepine and cyclopyrrolone reduction in general practice--does this lead to change in the use of antidepressants? A study based on a Danish population.

BACKGROUND: The consumption of benzodiazepines and cyclopyrrolones has in recent years attracted considerable interest due to serious side effects. In twelve health care practices in Denmark a few simple rules to reduce the consumption were established. Telephone recipes were abolished, and prescriptions were issued for only a single month's usage and only following personal consultation. These rules are generally in accordance with recommendations applicable in, for example, England, Norway and Denmark. After 15 months, consumption was roughly halved. There is a general lack of knowledge about whether an intervention as described above leads to a substitution with other medicines. Here, especially antidepressants are in the spotlight. METHODS: In the twelve health care practices, the consumption of antidepressants before, during and after the intervention was followed. RESULTS: The total consumption of antidepressants rose by 5.2% per year during the 18 month observation period. This should be compared to the fact that the county had an increase of 8.6% per year during the same period. This increase occurred mainly in the group of selective serotonin reuptake inhibitors. LIMITATIONS: The study does not provide information about prescription changes for individual users, or for changes in the number of users. The study is limited to the total prescribed volume of antidepressants. CONCLUSION: The average prescription volume for the twelve health care practices corresponds to a relative decline. Fears that an intervention of the type mentioned above would lead to an uncontrollable increase in the consumption of antidepressants are unfounded.

[Benzodiazepine reduction does not imply an increased consumption of antidepressants. A survey of two medical practices]. / Benzodiazepinaftrapning medfører ikke øget forbrug af antidepressiva. En undersøgelse fra to laegepraksis.

INTRODUCTION: The consumption of benzodiazepines (BZ) and cyclopyrrolones (CP) has attracted great interest in recent years due to the serious side-effects associated with these drugs. Two medical practices introduced a more restrictive approach to the prescription of BZ and CP. The intervention reduced the total consumption of anxiolytica by 75% and hypnotica by 90% during the two and a half year period. There is a general lack of knowledge about whether an intervention of this nature reduces drug consumption in general, or merely substitutes the consumption of drugs. Here, antidepressants (AD) are especially relevant substitutes. MATERIAL AND METHODS: In two medical practices, the consumption of AD was followed before, during and after the intervention. Consumption was followed via the Danish Medicines Agency's website Ordiprax, which listed the amount of prescription medicines sold from pharmacies. RESULTS: The total quantity of prescribed AD remained unchanged in the two practices (p = 0.05). There were minor shifts in prescription classes. This result should be seen in the context of the consumption of AD in the county as a whole, which rose by 8.6% per annum during the intervention period. CONCLUSION: In the primary sector, it is possible to reduce the amount of BZ and CP without causing a concomitant increase in the prescription of AD. The two medical practices of the present survey did not introduce a deliberately restrictive approach, but simply an increasing awareness when prescribing to patients, especially regarding the duration of prescriptions.

Reducir el uso de benzodiazepinas y ciclopirrolonas en práctica clínica / Reducing the use of benzodiazepines and cyclopyrrolones in clinical practice

Objetivo: Recientemente, el uso de benzodiazepinas (BZD) y ciclopirrolonas (CP) ha absorbido gran atención. Unos 100.000 pacientes -aproximadamente el 2% de la población danesa- se cree que son adictos a las BZD. Este artículo describe un método simple y efectivo para reducir el uso de medicamentos productores de dependencia en la práctica clínica. Métodos. Diseño: Se implantaron las leyes locales de acuerdo con la Directiva danesa CIR nº 12 13/01/2003 relativa a los medicamentos adictivos. Las recetas de BZD y CP se emitieron mensualmente y solo después de consulta personal. Esta prescripción mensual forzaba al médico y al paciente a evaluar si la prescripción estaba indicada o si debería introducirse una reducción de pauta. La prescripción fue monitorizada usando el Sistema Ordiprax (Instituto para la Farmacoterapia Racional, IRF), que registra las ventas de las farmacias con recetas de médicos generales. Se investigó en dos clínicas individuales en Thyborøn - Condado de Harboøre, que cubren unos 2300 pacientes. Se incluyeron en el estudio todos los pacientes que usaban BZD o CP, con la excepción de los que sufrían desordenes mentales graves. Resultados: Después de 15 meses, el uso de BZD y CP se redujo en el 50% y el 75% respectivamente. El proceso de cambio de hábitos de prescripción fue más fácil de lo esperado. Apareció un grupo de pacientes inicialmente invisible para el médico. Durante los tres primeros meses, fueron necesarias solo 4-5 consultas adicionales por cada 1000 pacientes. No se necesitó apenas ayuda de los colegas habituales, como psiquiatras, hospitales, unidades especializadas para tratamiento de adictos. Conclusión: Cuando se prescriben BZD o CP, recomendamos enérgicamente que se incorporen estos procedimientos simples a la rutina diaria (AU)

Objective: Recently, the use of benzodiazepines (BZD) and cyclopyrrolones (CP) has drawn a great deal of attention. About 100,000 patients -approximately 2% of the Danish population -are believed to be addicted to BZD. This article describes a simple and effective method of reducing the use of dependency-producing drugs in clinical practice. Methods: Design: Local rules were implemented according to Danish directive CIR nr 12 13/01/2003 regarding addictive drugs. Prescriptions for BZD and CP were only issued on a monthly basis, and only following personal consultation. This monthly requirement forced the physician as well as the patient to evaluate whether the existing prescription pattern was indicated, or whether a drug-reducing regime should be introduced. The prescription pattern was monitored using the Ordiprax System (Institute for Rational Pharmacotherapy, IRF), which records pharmacy's sales of prescription drugs as prescribed by clinical practices. Two individual clinics in Thyborøn - Harboøre Community, covering some 2300 patients, were surveyed. All patients using BZD or CP were included in this study, with the exception of patients suffering from serious psychiatric or physical disorders. Results: After 15 months, the use of BZD and CP was reduced by 50% and 75%, respectively. The process of changing prescription habits was far easier than expected. A whole group of patients, initially invisible to the physician, was exposed. During the first three months, as few as 4-5 additional consultations for every 1000 patients was required. There was essentially no need for assistance from our usual partners, including psychiatrists, hospitals, specialist units for addictive treatment. Conclusion: We strongly recommend that these simple procedures be incorporated into daily routine when prescribing either a BD or a CP (AU)

[Reducing the use of addictive drugs in clinical practice]. / Reduktion af vanedannende medicin i praksis!

INTRODUCTION: The use of benzodiazepines (BDs) and cyclopyrrolones (CPs) has drawn a great deal of political attention over the past years. There are estimated to be approximately 100,000 BD addicts in Denmark. This article describes a simple but effective method of reducing the use of addictive drugs in clinical practice. MATERIALS AND METHODS: Two solo clinics in Thyborøn-Harboøre Community decided to work strictly according to directive CIR no. 12 of 13 January 2003. All BDs and CPs were prescribed for one month at a time and could be renewed only by the doctor after a personal consultation. This monthly requirement forced the doctor as well as the patient to evaluate whether the existing prescription pattern or a drug-reducing regime was indicated. The prescription pattern was monitored using Ordiprax, which showed the amount of prescription medicines sold by pharmacies. RESULTS: After 15 months, the patients" use of BD was reduced by 50% and their use of CP by 75%. The process of changing prescription habits was far easier than expected. An entire group of patients, previously invisible to the doctors, was exposed. During the first three months, only four to five additional consultations for every 1,000 assigned patients were required each week. There was practically no need of any assistance from our usual partners, such as psychiatrists, hospitals, special wards for addictive treatment or primary health care. CONCLUSION: We strongly recommend that this simple procedure be made a daily routine when prescribing either a BD or a CP.

Reducing the use of benzodiazepines and cyclopyrrolones in clinical practice.

OBJECTIVE: Recently, the use of benzodiazepines (BZD) and cyclopyrrolones (CP) has drawn a great deal of attention. About 100,000 patients - approximately 2% of the Danish population - are believed to be addicted to BZD. This article describes a simple and effective method of reducing the use of dependency-producing drugs in clinical practice. DESIGN: Local rules were implemented according to Danish directive CIR nr 12 13/01/2003 regarding addictive drugs. Prescriptions for BZD and CP were only issued on a monthly basis, and only following personal consultation. This monthly requirement forced the physician as well as the patient to evaluate whether the existing prescription pattern was indicated, or whether a drug-reducing regime should be introduced. The prescription pattern was monitored using the Ordiprax System (Institute for Rational Pharmacotherapy, IRF), which records pharmacy's sales of prescription drugs as prescribed by clinical practices. Two individual clinics in Thyborøn - Harboøre Community, covering some 2300 patients, were surveyed. All patients using BZD or CP were included in this study, with the exception of patients suffering from serious psychiatric or physical disorders. RESULTS: After 15 months, the use of BZD and CP was reduced by 50% and 75%, respectively. The process of changing prescription habits was far easier than expected. A whole group of patients, initially invisible to the physician, was exposed. During the first three months, as few as 4-5 additional consultations for every 1000 patients was required. There was essentially no need for assistance from our usual partners, including psychiatrists, hospitals, specialist units for addictive treatment. CONCLUSION: We strongly recommend that these simple procedures be incorporated into daily routine when prescribing either a BD or a CP.