title: Did the new French pay-for-performance system modify benzodiazepine prescribing practices?
abstract: BACKGROUND
  French general practitioners (GPs) were enrolled in a new payment system in January 2012. As part of a national agreement with the French National Ministry of Health, GPs were asked to decrease the proportion of patients who continued their benzodiazepine treatment 12 weeks after its initiation and to decrease the proportion of patients older than 65 who were prescribed long half-life benzodiazepines. In return, GPs could expect an extra payment of up to 490 euros per year. This study reports the evolution of the corresponding prescribing practices of French GPs during that period regarding patients who were prescribed a benzodiazepine for the first time.
  
  
  METHODS
  The national healthcare system's administrative database was used to report the longitudinal follow-up of two historical cohorts of French patients from the Pays de la Loire area.
  
  
  METHODS
  The "2011" and "2012" cohorts included all patients who initiated benzodiazepine regimens from April 1 to June 30 in 2011 and 2012, respectively.The primary outcomes were the proportion of those study patients who continued benzodiazepine treatment after 12 weeks and the proportion of study patients >65 years who were prescribed long half-life benzodiazepines.Analyses were performed using a multi-level regression.
  
  
  RESULTS
  In total, 41,436 and 42,042 patients initiated benzodiazepine treatment in 2011 and 2012, respectively. A total of 18.97% of patients continued treatment for more than 12 weeks in 2012, compared with 18.18% in 2011. In all, 27.43% and 28.06% of patients >65 years continued treatment beyond 12 weeks in 2011 and 2012, respectively. The proportion of patients >65 years who were prescribed long half-life benzodiazepines decreased from 53.5% to 48.8% (p < 0.005) due to an increase in short half-life benzodiazepine prescriptions. Patients >65 years who were prescribed short half-life benzodiazepines were more likely to continue treatment after 12 weeks (p < 0.005).
  
  
  CONCLUSIONS
  Despite the pay-for-performance strategy, the number of short half-life benzodiazepine prescriptions increased between 2011 and 2012, and the number of long half-life benzodiazepine initiations remained unchanged. Reducing the proportion of long half-life benzodiazepine prescriptions might be counterproductive because prescribing short half-life benzodiazepines was associated with higher rates of continuation beyond the recommended duration.
authors.affiliation: Department of General Practice, Faculty of Medicine, 1 rue Gaston Veil, 44035 Nantes, France. cedric.rat@univ-nantes.fr.
authors.forename: Cédric
authors.initials: C
authors.lastname: Rat
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Penhouet
authors.forename: Aurélie
authors.initials: A
authors.lastname: Gaultier
authors.forename: Anicet
authors.initials: A
authors.lastname: Chaslerie
authors.forename: Jacques
authors.initials: J
authors.lastname: Pivette
authors.forename: Jean Michel
authors.initials: JM
authors.lastname: Nguyen
authors.forename: Caroline
authors.initials: C
authors.lastname: Victorri-Vigneau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001569:Benzodiazepines / Q000627:therapeutic use*; D005260:Female; D005602:France; D058006:General Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012052:Reimbursement, Incentive
chemical_list: D001569:Benzodiazepines