Characteristics of GP and study populations
Questionnaires were returned by 350 GPs, which represents a response rate of 36.1% (350/967). Among the non-responders, the reason for non-participation was a lack of time to answer (90.1%, 128/142) or lack of interest in the objective of the study (8.9%, 16/142). Responders practised in all 22 regions of the country, had been practising for an average of 16 years, were predominantly male (84.8%), and had a mean age of 44 years. Participating GPs were significantly younger than non-responding GPs (44 years versus 55 years, P<0.001); they did not significantly differ in terms of sex or location of practice (rural or urban areas).
On their last working day, responder GPs saw 2498 patients aged ≥65 years. GPs declared that these older patients were consulting for a physical problem, a psychological problem, or both, in 55.8% (1394/2498), 37% (924/2498), and 7.2% (180/2498) of cases respectively. These patients were taking an anxiolytic/hypnotic in 32.1% (803/2498) of cases, antidepressants in 17.5% (438/2498) of cases, and antipsychotic treatment in 8.1% (202/2498) of cases.
GPs' opinions about psychotropic use for individuals aged ≥65 years
When asked if they knew the six national guidelines for managing people with anxiety and/or insomnia, 22% (191/349) of GPs declared that they did, while 82% knew at least one of these guidelines. One of the guidelines, ‘How to stop benzodiazepine and benzodiazepine-related drugs (Z-drugs) among older patients’,18
was reported to be the best known (70% of GPs).
Pressure by patients to initiate or renew prescription of anxiolytics/hypnotics had previously been felt by 97.1% of GPs (). However, 90.5% declared that it was possible to reduce or stop treatment for their patients. GPs felt that more information should be distributed to the general population (84%) as well as to physicians (80%). Lastly, GPs agreed that greater access to psychiatrists could help to reduce prescription of psychotropic drugs ().
GPs' opinions about prescriptions for psychotropic drugs among patients aged ≥65 years.
GPs' general opinions on ways to reduce anxiolytic/hypnotic prescriptions among patients aged ≥65 years.
Psychotropic consumption: patient-based data
Psychotropic consumption of 339 patients is described in . Patients were aged a mean of 77.3 years (SD = 7.5), mostly female (70.8%, 240/339), and were living alone (46.5%, 157/338), with their family (40.8%, 138/338), or in an institution (12.8%, 43/338).
Psychotropic consumption in 339 patients aged ≥65 years.
Overall, 195 of the 339 patients were taking at least one anxiolytic, 140 patients were taking at least one hypnotic, and 193 patients were taking at least one antidepressant. Anxiolytics were the most commonly used drugs (57.5%, 195/339), with a proportion of exclusive users of 22.1% (75/339).
The anxiolytics most frequently prescribed were lorazepam (22.6%, 44/195), bromazepam (21.0%, 41/195), and alprazolam (13.3%, 26/195). Hypnotics were used by 41.3% of patients (140/339), with a proportion of exclusive users of 15.9% (54/339). The most frequently prescribed hypnotics were zolpidem (57.1%, 80/140) and zopiclone (27.8%, 39/140). Antidepressants were used by 56.9% of patients receiving a psychotropic drug (193/339), with a proportion of exclusive users of 14.7% (50/339). The types of antidepressants reported were specific serotonin reuptake inhibitors (52.8%, 102/193), specific noradrenaline (norepinephrine) reuptake inhibitors (15.5%, 30/193), tianeptine (12.9%, 25/193), mianserine (11.4%, 22/193), and tricyclics (7.3%, 14/193).
The most frequent drug combinations were anxiolytics with antidepressants (12.6%, 74/339), followed by antidepressants combined with hypnotics (11.8%, 40/339). Among the 291 patients who were under an anxiolytic or hypnotic drug, the treatment duration was over 1 year in 68.4% of cases (199/291). The main indication for anxiolytics or hypnotics was anxiety (71.8%, 209/291), chronic insomnia (60.1%, 175/291), and/or depression (31.9%, 93/291). Among the 193 patients who were taking antidepressants, the treatment duration was over 1 year in 43.5% of cases (84/193; ). They were prescribed for depression (93.3%, 180/193) and/or anxiety (45.1%, 87/193).
Psychotropic drug use was inappropriate in 84.3% (285/339) of cases, owing to long-acting benzodiazepine use (7.6%, 26/339), concomitant use of three or more psychotropic drugs (8.6%, 29/339), or the use of benzodiazepines or Z-drugs for more than 3 months (84.2%, 285/339).
GPs stated that it was impossible to reduce or stop anxiolytic or hypnotic treatment for 57% of patients (166/291), whereas 27.1% (79/291) agreed that it could be possible. Forty-six GPs had no opinion. GPs rated that 68.1% (199/291) of the patients were physically dependent on their anxiolytics/hypnotics, 32.9% (96/291) were psychologically dependent, and 30.4% (198/291) physically and psychologically dependent. Dependence on antidepressants was estimated to be 20.7% (40/193), 32.4% (41/193), and 15.5% (30/193) for physical, psychological, or both types of dependence respectively.
Barriers to reducing the dosage or to stopping anxiolytics/hypnotics for these patients are presented in . The principal barriers reported were patients' refusal (79%), absence of reimbursement of psychotherapy (79%), or no local offer of psychotherapy available (73%), and absence of any other alternative therapy (70%).
Barriers to reduce or stop anxiolytic or hypnotic drugs in patients aged ≥65 years.