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Prescribing of hypnotics in general practice: perceived barriers and the effectiveness of a brief intervention service Custom Essay

March 25, 2016

Prescribing of hypnotics in general practice: perceived barriers and the effectiveness of a brief intervention service Custom Essay

ABSTRACT Objective: To find out how general practitioners express the barriers to appropriate prescribing of Z-drugs and benzodiazepines using a COM-B model. Background: Inappropriate drug prescription is a common phenomenon in many primary healthcare settings. Inappropriate prescription of Z-drugs and benzodiazepines has adverse effects, especially in the older population. Regardless, physicians continue prescribing the drugs to them. Data Sources: CINAHL, Medline (PubMed), PsycINFO, SCOPUS, Web of Science, Science Direct, ProQuest and Springer. Eligibility for selecting studies: Qualitative or quantitative studies about the perceptions and experiences of general practitioners in the prescription of Z-drugs and benzodiazepines. The studies had to be in the English language, conducted in primary healthcare settings between 2000 and 2015 in the United States, Europe, Australia or New Zealand. Methods: Various databases were searched for relevant research articles. Results were analysed using thematic analysis and themes drawn according to the COM-B model. The barriers and reasons identified from the study were grouped into themes and classified under Capability, Opportunity or Motivation. Results: Physicians reported several reasons and barriers for the inappropriate prescription. They include inadequate information, persistent patients, challenging work environment, type of drug, unwillingness to discontinue medication, inadequate or lack of knowledge about alternatives, and empathy for the patients and lack of alternatives. Conclusion: Barriers related to motivation, capability and opportunity caused inappropriate prescription of Z-drugs and benzodiazepines. Intervention strategies should be aimed at the three to resolve the inappropriate prescription crisis. Primary Objective: To investigate the impact of a brief intervention service aimed at reducing the prescribing of hypnotics in two General Practices (GP) settings in East Berkshire Clinical Commissioning Group (CCG) within a before and after audit study that examines the process as well as the outcomes of this service. Primarily to examine the prescribing rate of hypnotics within the two GP practices. In addition, to investigate the processes involved and gain the views of patients and GP staff in relation to the service and the determinants of behaviours relating to hypnotic prescribing. The brief intervention service will use an existing service template that was successfully delivered in 2013/14 to one GP practice within East Berkshire CCG. This is detailed in the section ‘Summary of Study Design’. The prescribing of hypnotics will be quantified using hypnotic Average Daily Quantity (ADQ) data per STAR-PUs (Specific Therapeutic Group Age-sex weightings Related Prescribing Units) and compared at a local and national level at baseline, during and after the study period. The views of patients and practice staff will be obtained using qualitative interview and will be examined using thematic analysis. The ultimate aim is to objectively investigate the hypothesis that the provision of this service will reduce the prescribing of hypnotics by impacting on determinants of prescribing behaviours. Secondary outcomes 1. The patient and GP views about the service and any mechanisms of behaviour change through thematic analysis of interviews 2. An additional analysis that highlights opportunities for further behaviour change. Clear recommendations for progressing a separate future study that measures the impact of a similar service evaluation on a larger population


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