Keywords: benzodiazepines, medical costs, general practice, family medicine, European countries
Balancing benefits versus harms should not lead clinicians to long-term benzodiazepine (BZD) prescription. Nonetheless, BZD and z-drugs are widely prescribed beyond the recommended duration in France, Spain or Belgium, while prescription rates are low in Germany and UK. There are large variations among European countries (ESEMeD survey, European panorama, OECD report).
Are there specificities, either related to General Practitioners (GPs) practices or to patients’ behaviors, that might impact the management of insomnia and anxiety?
The study objective will be to analyze national specificities related to the management of insomnia and anxiety in general practice.
The project will be based on 3 steps:
1. Elaboration of validated tools: an observation grid and a self-administered questionnaire focusing on anxiety and insomnia management. This step will be based on Delphi rounds, and will require the involvement of an international working group.
2. Description of anxiety and insomnia management in primary care:
a. A participant observation of GPs consultations performed by a trainee (student, intern…), on consecutive consultations, up to 4 days/month, for 5 to 6 months. We intend to collect sociodemographic data, consultations data based on CISP, and specific outcomes related to insomnia/anxiety management, using the grid elaborated in step 1.
b. A survey focusing on the patients’ way of dealing with anxiety or insomnia, using validated questionnaire developed in step 1 about patients own management (on the model of COCO study).
3. After data-analysis, a triangulation of the results (GPs practices, patients’ perspectives, and OECD drugs data) will be performed in order to build explanatory assumptions for these differences.
No results at this time.
This study should provide a better understanding of national specificities between European countries in the management of anxiety and insomnia, and allow optimization of BZD prescription.
Points for discussion:
1. First step: we are open to discussion on how to develop consensus tools (face-to-face working group, Delphi round...)
2. Second step: the method needs to be adapted to the different kind of practices in each country, depending on the presence or not of trainees, the organization of GPs, etc.
3. Third step: we considered doing qualitative interviews (3 to 5 volunteer GPs for each country) to help analyzing the differences reported in the participant observation, the survey among patients and the OECD data