Grimmsmann Thomas, Himmel Wolfgang
Medical Service Mecklenburg-Vorpommern, Schwerin, Germany.
Department of General Practice, University Medical Center Göttingen, Göttingen, Germany.
Pharmacoepidemiol Drug Saf. 2023 Jan;32(1):60-65. doi: 10.1002/pds.5536. Epub 2022 Sep 27.
To analyse (1) how often patients insured under the statutory health insurance (SHI) scheme received repeated prescriptions for benzodiazepines or Z-drugs as private prescriptions and (2) how often doctors switched from SHI prescriptions to private prescriptions and vice versa when issuing repeat prescriptions.
On basis of anonymized prescriptions from 874 ambulatory practices in Germany, we analysed the percentage of private prescriptions for Z-drugs, benzodiazepines/anxiolytics, and benzodiazepines/hypnotics and sedatives over 6 years (2014 to 2020).
Of 2 200 446 prescriptions for a benzodiazepine or Z-drug, 38% were private prescriptions. In case of Z-drugs, the rate of private prescriptions was 44.1% for single prescriptions and 48.9% for refills. The difference was smaller for anxiolytics (23.3% vs. 26.0%) and, for benzodiazepine/hypnotics and sedatives, the proportion of private prescriptions for refills was even lower than for single prescriptions. In case of Z-drugs, the proportion of private prescriptions was, on average, 42.7% for the first prescription of a series of repeat prescriptions and 49.6% for the tenth prescription. The increase was smaller for anxiolytics and negligible for benzodiazepine/hypnotics and sedatives. Doctors stayed with their initial decision in more than three quarters of repeat prescriptions, be it a SHI or private prescription.
While we observed a large number of private prescriptions for benzodiazepines and Z-drugs, the proportion was only slightly higher for refills than for single prescriptions. Doctors do not seem to issue private prescriptions as a strategy to mask especially long-term use of these substances.
分析（1）法定医疗保险（SHI）计划覆盖的患者将苯二氮䓬类药物或Z类药物重复处方作为私人处方的频率，以及（2）医生在开具重复处方时从SHI处方转换为私人处方以及反之亦然的频率。
基于德国874家门诊诊所的匿名处方，我们分析了6年（2014年至2020年）内Z类药物、苯二氮䓬类/抗焦虑药以及苯二氮䓬类/催眠药和镇静剂的私人处方百分比。
在2200446份苯二氮䓬类药物或Z类药物处方中，38%为私人处方。对于Z类药物，单次处方的私人处方率为44.1%，续方的私人处方率为48.9%。抗焦虑药的差异较小（23.3%对26.0%），对于苯二氮䓬类/催眠药和镇静剂，续方的私人处方比例甚至低于单次处方。对于Z类药物，在一系列重复处方中，第一张处方的私人处方比例平均为42.7%，第十张处方为49.6%。抗焦虑药的增长较小，而苯二氮䓬类/催眠药和镇静剂的增长可忽略不计。在超过四分之三的重复处方中，医生维持其最初的决定，无论是SHI处方还是私人处方。
虽然我们观察到大量苯二氮䓬类药物和Z类药物的私人处方，但续方的比例仅略高于单次处方。医生开具私人处方似乎并非是为了掩盖这些药物的长期使用。
