Capsule Commentary on Magin et al., Changes in Australian Early-Career General Practitioners’ Benzodiazepine Prescribing: a Longitudinal Analysis
Capsule Commentary on Magin et al., Changes in Australian Early-Career General Practitioners' Benzodiazepine Prescribing: a Longitudinal Analysis
Benjamin J. Oldfield benjamin.oldfield@yale 0 1
0 Compliance with Ethical Standards:
1 Yale School of Medicine , New Haven, CT , USA
T by Magin et al.1 examined changes in benzodiazepine
his multi-site cohort study of general practitioner trainees
prescribing from 2010 through 2015. The investigators
examined self-completed case reports of 1161 Australian
generalpractitioner registrars (postgraduate learners in outpatient
practice-based training) across five diverse training programs
over time. After adjusting for registrar- and patient-level
characteristics, they found that the within-registrar adjusted odds
of reported benzodiazepine prescribing did not change over
time, but the within-program adjusted odds of prescribing
decreased by 6% per year. Assuming that these trends reflect
efforts towards more judicious prescribing, the investigators
conclude a reduction in benzodiazepine prescriptions by
program—a welcome trend—but a lack of change by registrar
suggests opportunities for targeted education.
This study addresses an important gap in our
understanding of benzodiazepine prescribing patterns, and its
novel focus on primary care trainees shifts our gaze
Bupstream^ towards early-career clinicians who may be
establishing durable prescribing practices.2 The study’s internal
validity is strengthened by the registrars’ high response
rate (96%); generalizability to Australian general
practitioner training programs is supported by its large sample
across diverse geographic areas. However, postgraduate
medical education is a heterogeneous enterprise wherein
prescribing often depends on complex interactions
between trainees, supervisors, and educational activities, so
attributing the observed trends to policy, practice, or
education efforts is speculative.
Due to increases in overdose deaths involving
benzodiazepines, inappropriate prescribing of benzodiazepines has been
termed the Bother prescription drug problem^ in the United
States, and safer prescribing is needed globally.3 This study
conveys to clinicians, educators, and policymakers that there is
room for improvement in postgraduate medical education
regarding safe benzodiazepine prescribing. A deeper dive into
the higher performing programs in this study may identify
successful strategies. Furthermore, ongoing efforts to improve
opioid prescribing safety such as through academic detailing4
or prescription drug monitoring programs5—efforts supported
by accumulating evidence and resources—may provide
models and existing infrastructure for educational programs
that promote evidence-based benzodiazepine prescribing.
These programs should be evaluated and implemented.
Conflict of Interest: The author has no conflicts of interest to disclose.
1. Magin P , Tapley A , Dunlop AJ , Davey A , van Driel M , Holliday E , et al. Changes in Australian early-career general practitioners' benzodiazepine prescribing: a longitudinal analysis . J Gen Intern Med . (SPI 4577).
2. Wiese HJC , Piercey RR , Clark CD . Changing Prescribing Behavior in the United States: Moving Upstream in Opioid Prescription Education . Clin Pharmacol Ther . 2018 ; 103 ( 6 ): 982 - 9 . doi:https://doi.org/10.1002/cpt. 1015
3. Lembke A , Papac J , Humphreys K. Our Other Prescription Drug Problem. N Engl J Med . 2018 ; 378 ( 8 ): 693 - 5 . doi:https://doi.org/10. 1056/NEJMp1715050
4. Trotter Davis M , Bateman B , Avorn J . Educational Outreach to Opioid Prescribers: The Case for Academic Detailing. Pain Physician . 2017 ; 20 ( 2S ): S147 - S51 .
5. Bao Y , Pan Y , Taylor A , Radakrishnan S , Luo F , Pincus HA , et al. Prescription Drug Monitoring Programs Are Associated With Sustained Reductions In Opioid Prescribing By Physicians . Health Aff (Millwood) . 2016 ; 35 ( 6 ): 1045 - 51 . doi:https://doi.org/10.1377/hlthaff. 2015 .1673