Gaining insight into benzodiazepine prescribing in General Practice in France: a data-based study

BACKGROUND: In recent decades, benzodiazepine (BZD) prescriptions have been called into question in most European countries by physicians and health authorities alike, and guidelines on medical indications and treatment duration have been established to avoid long-term use and dependency. In France, many public policy measures have been implemented as BZDs are among the most prescribed medications. General practitioners (GPs) were identified by the Caisse d'Assurance Maladie (the French public health insurance fund) as high prescribers for these drugs. In this context, the aim of the study was to determine GPs' rates and to identify correlates of BZD and Z-drugs prescribing. METHODS: Data on patient characteristics, diagnoses and BZD prescriptions were drawn from French GPs' electronic medical records. These were accessed via the database which the Société Française de Médecine Générale, the French Society of General Practice, has been compiling since 1993 in a network of 90 GPs working mainly in solo practices. The participants in this network routinely register data in their daily practice. The present study examined 51,216 patients from 52 GP practices and we performed a multivariate logistic regression. The dependent variable was whether a patient was prescribed BZD at least once during 2006. RESULTS: In the present study, 12.5% of patients older than 18 were prescribed BZDs at least once during 2006 and the average (SD) was 2.6 (2.4) BZD prescriptions/patient/year. The adjusted odds (confidence interval) of having at least one BZD prescription were 1.20 (1.10 - 1.30) in patients older than 65; 1.05 (1.01 - 1.10) in women; 1.25 (1.17 - 1.33) in patients with associated comorbidities (cardiovascular diseases) and 1.76 (1.62 - 1.92) in heavy consumers of health care (more than 4 consultations with a GP per year). CONCLUSIONS: The present study showed the persistence of high rates of BZD prescription by GPs, particularly in women and older patients, which highlights the difficulties of implementing effective public policies and the necessity of using new approaches enabling doctors and patients to understand the true relative advantages, disadvantages, and consequences of using these drugs and of non-pharmaceutical treatments.