title: Primary care hypnotic and anxiolytic prescription: Reviewing prescribing practice over 8 years.
abstract: BACKGROUND
  Over the last few years, hypnotic and anxiolytic medications have had their clinical efficacy questioned in the context of concerns regarding dependence, tolerance alongside other adverse effects. It remains unclear how these concerns have impacted clinical prescribing practice.
  
  
  METHODS
  This is a study reviewing community-dispensed prescribing data for patients on the East Practice Medical Center list in Arbroath, Scotland, in 2007, 2011 and 2015. Anxiolytic and hypnotic medications were defined in accordance with the British National Formulary chapter 4.1.1 and chapter 4.1.2. All patients receiving a drug within this class in any of the study years were collated and anonymized using primary care prescribing data. The patients' age, gender, name of the prescribed drug(s), and total number of prescriptions in this class over the year were extracted.
  
  
  RESULTS
  The proportion of patients prescribed a benzodiazepine medication decreased between 2007 and 2015: 83.8% (n= 109) in 2007, 70.5% (n= 122) in 2011, and 51.7% (n= 138) in 2015 (P= 0.006). The proportion of these patients prescribed a nonbenzodiazepine drug increased between 2007 and 2015: 30% (n= 39) in 2007, 46.2% (n= 80) in 2011, and 52.4% (n= 140) in 2015 (P= 0.001). There was a significant increase in the number of patients prescribed melatonin (P= 0.020).
  
  
  CONCLUSIONS
  This study reports a reduction in benzodiazepine prescriptions in primary care alongside increases in nonbenzodiazepine and melatonin prescribing, with an increase in prescribing rates of this drug class overall.
  
  
  CONCLUSIONS
  Changes in this prescribing practice may reflect the medicalization of insomnia, local changes in prescribing practice and alongside national recommendations.
authors.affiliation: Senior House Officer, Geriatric & Stroke Medicine, NHS Lothian, United Kingdom.
authors.forename: Lloyd D
authors.initials: LD
authors.lastname: Hughes
authors.affiliation: Springfield Medical Centre, Arbroath, Scotland, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: Raitt
authors.affiliation: Springfield Medical Centre, Arbroath, Scotland, United Kingdom.
authors.forename: Muhammed Awais
authors.initials: MA
authors.lastname: Riaz
authors.affiliation: Springfield Medical Centre, Arbroath, Scotland, United Kingdom.
authors.forename: Sarah-Jane
authors.initials: SJ
authors.lastname: Baldwin
authors.affiliation: Springfield Medical Centre, Arbroath, Scotland, United Kingdom.
authors.forename: Kay
authors.initials: K
authors.lastname: Erskine
authors.affiliation: Springfield Medical Centre, Arbroath, Scotland, United Kingdom.
authors.forename: Gail
authors.initials: G
authors.lastname: Graham
keywords: Anxiolytic; benzodiazepines; hypnotic; nonbenzodiazepines; prescribing; primary care