Mental health disorders such as depression and insomnia are prevalent in the community; the use of antidepressants and benzodiazepines is therefore common. However if these medications are not prescribed and used appropriately issues relating to safety and/or efficacy can occur. There is also some concern about the misuse of benzodiazepines by the injecting drug user (IDU) community. The overall aim of this PhD was to perform international utilization comparison studies and analyze national prescribing data to understand and describe factors influencing the use of prescription medicines, in particular antidepressants and benzodiazepines, and to develop some ideas and initiatives to improve future use. Comparisons in the prescribing of benzodiazepines and antidepressants between Nova Scotia, Canada and Australia were undertaken. Dispensing data for all publicly subsidized benzodiazepines and related compounds and antidepressant classes of medications and utilization was compared from 2000-2003, using the World Health Organisation ATC/ DDD system. Australian dispensing data were also used to examine changes in the utilization of antidepressants and benzodiazepines between different age groups within Australia from 2003-2006. Dispensing data and numerical data derived from reports from Australia’s Illicit Drug Reporting System (IDRS) were used to estimate benzodiazepine use by those who inject heroin, in areas with high proportion of persons who inject heroin in Sydney, Melbourne and Brisbane. To determine a strategy aimed at improving the use of benzodiazepines, the literature was searched and the latest interventions, solely focusing on increasing appropriate prescribing and reducing long term use of benzodiazepines worldwide were retrieved and analyzed. The comparison studies showed the use of benzodiazepines increased at a steady but comparable rate in both Australia and Nova Scotia, although overall use was much higher in Nova Scotia than Australia (123 and 48 DDD/1000 beneficiaries/day, respectively). However, the use of antidepressants in Nova Scotia increased at a higher rate than Australia. The variations between the two jurisdictions may be due to the more limited range of benzodiazepines available in Australia, or perhaps different initiatives to control. The differences may also be due to increased exposure to marketing, promotion, education or different prescribing practices in Nova Scotia compared to Australia. From 2003 to 2006, the use of antidepressants increased with age, with those over 65 years having the greatest use (86.9 and 97.7DDD/1000 population/day, respectively). Differences were also seen in the antidepressant most utilized, with the elderly using more tricyclic antidepressants than those who were younger. The utilization of benzodiazepines decreased from 2003-2006 in the same population (66.6 and 61 DDD/1000 concession beneficiaries/day, respectively). However, those over 85 had the highest use of benzodiazepines and used more long acting benzodiazepines than those aged 35-44. This demonstrates that the elderly still account for most use per capita of benzodiazepines. Some of this use may be inappropriate (e.g. use of long-acting benzodiazepines) and hence may provide a useful target for future educational intervention. The elderly also account for the largest per capita use of antidepressants. In areas with a high proportion of heroin IDU, the utilization of benzodiazepines by the estimated IDU population decreased (4064048DDDs in 2000 to 2613100 DDDs in 2006) however the overall use of benzodiazepines in Australia continued to increase from 2000-2006. This demonstrates that the increase in benzodiazepine utilization during this period was not primarily driven by use among IDU. The review identified three main target audiences at which interventions for improving the use of benzodiazepines were aimed at. These were consumers, General Practitioners or long term care facilities. Education, audit and feedback and alerts were the 3 major intervention approaches taken in the studies. The review concluded that studies which used a multi-factorial approach had the largest and most sustained reductions in benzodiazepines use. It appears that support groups for patients, non-voluntary recruitment of GPs, and oral delivery of alerts or feedback may all improve the outcomes of interventions. Using the review findings, an intervention targeting consumers and health professionals was conducted in a rural and urban area of Australia, using informative emails, bookmarks and website over a 6 month period. The intervention showed a significant decrease in the long term use of benzodiazepines within nursing homes located in the intervention geographical areas compared to the control areas. In conclusion the utilization studies revealed the current trends in utilization of antidepressants and benzodiazepines for Australia and led to the development of an intervention, based on factors that were found to influence prescribing of benzodiazepines. The intervention aimed at various target audiences did produce a small improvement in the prescribing of benzodiazepines.
| Identifer | oai:union.ndltd.org:ADTP/254034 |
| Creators | Alesha Smith |
| Source Sets | Australiasian Digital Theses Program |
| Detected Language | English |
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