title: The pattern of anxiolytic and hypnotic management by Australian general practice trainees.
abstract: Guidelines recommend anxiolytics and hypnotics (A/H) as second-line, short-term medications. We aimed to establish prevalence and associations of A/H prescribing by Australian general practice (GP) trainees.
  
  
  
  A cross-sectional analysis from a cohort study of vocational trainees from four GP Regional Training Providers during 2010-2013. General practice trainees act as independent practitioners (including for prescribing purposes) while having recourse to advice from a GP supervisor. Practice and trainee demographic data were collected as well as patient, clinical and educational data from 60 consecutive consultations of each trainee each training term. Analysis was at the level of individual problem managed, with the outcome factor being prescription of any anxiolytic or hypnotic.
  
  
  
  Overall, 645 registrars (response rate 94.0%) prescribed 68 582 medications in 69 621 consultations (with 112 890 problems managed). A/Hs were prescribed for 1.3% of problems managed and comprised 2.2% of all prescriptions. They were prescribed particularly for insomnia (28.2%) or anxiety (21.8%), but also for many 'off-label' indications. Significant associations of A/H prescriptions were: patient-level (greater age, Aboriginal and Torres Strait Islander status, English-speaking background, being new to the trainee but not to the practice); trainee-level (male) and consultation-level (longer duration, pre-existing problem, specialist referral not being made). Prescribing was significantly lower in one of the four Regional Training Providers.
  
  
  
  GP trainees, inconsistent with most guideline recommendations, prescribe A/Hs mainly as maintenance therapy to unfamiliar and older patients. Our results suggest that changes in management approaches are needed which may be facilitated by support for psychotherapeutic training. [Holliday SM, Morgan S, Tapley A, Henderson KM, Dunlop AJ, van Driel ML, Spike NA, McArthur LA, Ball J, Oldmeadow CJ, Magin PJ. The pattern of anxiolytic and hypnotic management by Australian general practice trainees. Drug Alcohol Rev 2017;36:261-269].
authors.affiliation: School of Medicine and Public Health, Faculty of Health, University of Newcastle, Newcastle, Australia.|Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia.
authors.forename: Simon M
authors.initials: SM
authors.lastname: Holliday
authors.affiliation: General Practice Training Valley to Coast, Newcastle, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Morgan
authors.affiliation: General Practice Training Valley to Coast, Newcastle, Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Tapley
authors.affiliation: General Practice Training Valley to Coast, Newcastle, Australia.
authors.forename: Kim M
authors.initials: KM
authors.lastname: Henderson
authors.affiliation: School of Medicine and Public Health, Faculty of Health, University of Newcastle, Newcastle, Australia.|Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia.
authors.forename: Adrian J
authors.initials: AJ
authors.lastname: Dunlop
authors.affiliation: Discipline of General Practice, School of Medicine, University of Queensland, Brisbane, Australia.
authors.forename: Mieke L
authors.initials: ML
authors.lastname: van Driel
authors.affiliation: Department of General Practice, University of Melbourne, Melbourne, Australia.|VMA General Practice Training, Melbourne, Australia.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Spike
authors.affiliation: Adelaide to Outback GP Training, Adelaide, Australia.
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: McArthur
authors.affiliation: Clinical Research Design, Information Technology and Statistical Support, Hunter Medical Research Institute, Newcastle, Australia.
authors.forename: Jean
authors.initials: J
authors.lastname: Ball
authors.affiliation: Clinical Research Design, Information Technology and Statistical Support, Hunter Medical Research Institute, Newcastle, Australia.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Oldmeadow
authors.affiliation: School of Medicine and Public Health, Faculty of Health, University of Newcastle, Newcastle, Australia.|General Practice Training Valley to Coast, Newcastle, Australia.
authors.forename: Parker J
authors.initials: PJ
authors.lastname: Magin
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D001315:Australia; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D058006:General Practice / Q000193:education; D058005:General Practitioners / Q000193:education / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D013997:Time Factors; D055815:Young Adult
chemical_list: D014151:Anti-Anxiety Agents; D006993:Hypnotics and Sedatives
keywords: anti-anxiety agents; drug overdose; family practice; general practitioners; hypnotics and sedatives