General Practitioners reduced benzodiazepine prescriptions in an intervention study: a multilevel application.
OBJECTIVE
This study investigated the effects of general practitioner, patient, and prescription characteristics on the reduction of long-term benzodiazepine prescribing by sending a letter to chronic users. The data were analyzed with a method respecting the hierarchical data structure.


METHODS
Data were obtained from 8,170 chronic users nested in 147 general practices. One thousand two hundred fifty-six chronic users in 19 general practices received a letter with the advice to reduce or stop the use of benzodiazepines after the general practitioners had attended a course on benzodiazepine use. In a three-level random intercept multilevel regression model, long-term prescribing of benzodiazepines was the dependent variable.


RESULTS
The reduction in benzodiazepine prescribing was significantly larger in the intervention than in the control group: 16% after 6 months and 14% after 12 months, respectively. The age of the patient, gender, and the interaction between age and gender were significant. The combination of the duration (long acting or short acting) with the type of benzodiazepine (anxiolytic or hypnotic) was an important pharmacological baseline covariate.


CONCLUSIONS
The reduction of benzodiazepine prescribing was mainly explained by the letter intervention and individual patient characteristics. Multilevel analysis was a worthwhile method for application in this study with its unbalanced design.
Stewart
Roy
R
University Medical Center Groningen, University of Groningen, Department of Public Health, 9713 AV Groningen, Netherlands. r.e.stewart@med.umcg.nl
Niessen
Wim J M
WJ
Broer
Jan
J
Snijders
Tom A B
TA
Haaijer-Ruskamp
Floor M
FM
Meyboom-De Jong
Betty
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014151:Anti-Anxiety Agents / Q000008:administration & dosage*; D001569:Benzodiazepines / Q000008:administration & dosage*; D015709:Correspondence as Topic; D004334:Drug Administration Schedule; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization; D004812:Epidemiologic Methods; D005194:Family Practice / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods
D014151:Anti-Anxiety Agents; D001569:Benzodiazepines