What action was taken in X Surgery?
SURGERY
Practice prescribing of hypnotics & benzodiazepines is measured and compared at a local (prescribing performance) and a national (QIPP indicator) level.
Why Audit?
* Continuing concern over long term use (1)
* Taking a benzodiazepine and/or hypnotic was associated with double the risk of death from any cause compared with no prescription for these drugs. Dose-response associations were found and there were approximately 4 excess deaths linked to these drugs per 100 people followed for an average of 7.6 years after their first prescription. (2)
* Driving whilst under the influence of drugs is a significant cause of injuries and deaths on the road. (3)
* Patients are not always given appropriate information and advice on the risks associated with long term use (4):
* Tolerance & addiction
* Drowsiness, clumsiness, forgetfulness, confusion, impaired judgement
* Falls & fractures – in people older than 60 years, these drugs are associated with an increased risk of falling of between 50-70% in relative terms. (5)
* Association with increased risk of dementia and increased cancer incidence in those prescribed high doses (6)
How is usage measured? Hypnotic ADQ per STAR PU – This is a measure of the total quantity of Benzodiazepines and Z-drugs prescribed, weighted for age and sex of a practice’s population.
At the start of the project x Surgery was the 4th highest prescriber out of 50 East Berkshire practices. x Surgery Q2 (Oct-Nov 13) 2013/14 ADQ 461
What action was taken in X Surgery?
1. Practice meeting to agree course of action with all prescribers. A consistent message is vital for success and helps to prevent patients pressurising or singling out a particular GP.
2. Search – patients prescribed these drugs during April – July 2013.
* Exclusion criteria: Housebound, care/nursing home (reviewed separately by care home pharmacist & responsible GP) and palliative care patients; one off supplies e.g. for back spasm, fear of flying and for epilepsy treatment.
3. Analysis consistently shows that a simple letter intervention reduces benzodiazepine use in patients who have been using them long-term (7). Letter sent to remaining patients to:
PLACE THIS ORDER OR A SIMILAR ORDER WITH US TODAY
