Hypnotic Prescription Without Face To Face Contact: A Report From French Family Medicine

Background: Guidelines suggest a review of hypnotic prescriptions every four weeks for zopiclone, zolpidem and zaleplon ('Z-drugs'). The lack of face-to-face consultation between the physician and the patient increases the potential of misuse and resultant dependence.Objectives : To determine the proportion of long-term hypnotic Z-drug prescription issued without face-to-face consultation, and factors associated with such practice.Method : Audit based on an extract of data from the French health insurance database in two French departments. Long-term Z-drug prescriptions by general practitioners (GPs) were analysed over a one-year period, regardless of the association of the prescription with a reimbursed consultation. Main factors considered were patient characteristics (gender, age, socioeconomic status, suffering from a chronic disease) and physician characteristics (gender, age, location of the practice, patient list size).Results: Overall, 67 256 long-term Z-drug prescriptions were reviewed. Of these, 23 107 (34.4%) were not associated with a consultation. Only 17% (95% CI: 16-18%) of long-term hypnotic consumers attended a consultation on all the dates noted on the prescription. Z-drug prescriptions were more likely to be prescribed in a consultation if the patient had a chronic illness (P < 0.0001), a low socioeconomic status (P < 0.0001), was less than 45 or over 65 years old (P < 0.0001), or visited a psychiatrist during the same year (P < 0.0001). Having a longer patient list or practising in a rural area were physician characteristics associated with non-adherent Z-drug prescription (P < 0.0001).Conclusion : Prescribing Z-drug hypnotics without a face-to-face consultation was frequent, especially in middle-aged patients without co-morbidity who were not seen by a psychiatrist.