In France, the prescription of benzodiazepines (BZD ) is a problem . Care for patients with chronic use is difficult. In terms of public health, it is particularly relevant to avoid this situation by prescribing these treatments wisely. A thesis carried out in 2012 resulted in the design of two brief first prescription of BZD guides , one to complaints for anxiety and the other for insomnia.
How would it be possible to assess the relevance of these guides, in actual practice conditions of general practice (GP) , knowing that the conditions of research in MG do not allow a large-scale intervention study ?
I am not sure what you mean by "assess the relevance of these guides"? What would you be interested in assessing? Are you interested in the process or outcome or both? I suggest you consider what the expected causal pathway would be - even drawing out as diagram, and then consider all the issues that may help/hinder the process leading to the outcome.
There are many different non-experimental approaches you can consider for evaluating the effectiveness of the guides, but the most potent will be a study that considers causal pathways. I am providing a link to a paper I recently wrote that may help you think about the issue. You can probably get sufficient understanding by just reading the introduction.
Article Using mediation analysis to identify causal mechanisms in di...
Ariel thank you for your reply, which leads me to ask me questions that I had not considered. In the end , which obviously interests me is the outcome , not financial but clinical . But consider the steps of the process that can lead to the desired outcome could be an interesting option . I will try to understand the mathematical formulation underlying theory to which your article refers . Do you have a practical example implementation of this theory ?
Frederic, I suggest that you think about the problem from a practical point of view as opposed to the math (which gets complicated in a hurry). As for an example, I provide a good one in the paper (the disease management example). There are plenty of others in health care as well, but unfortunately, few researchers take the time to consider what is the expected causal pathway, and is it supported by research, theory and common sense?
I love this discussion because it's so important. I spent the 70's (my first decade in private practice) getting people OFF benzos. My "decision support" is simple: NEVER use these drugs (always remember never to say always or never). UNLESS you have no choice. I never, prescribe them EXCEPT in a few circumstances: EtOH withdrawal, certain phobic reactions (such as flying, and only for the duration, w/ the caveats of memory loss, DVT etc), and those who have already become addicted by other physicians' unwise (in my opinion) prescribing. Now that we know that several if not most of the antidepressants are also excellent for anxiety, we can use other means, including NON-DRUG therapy, which also works very well. We certainly DO want to alleviate crippling anxiety or insomnia, but we'll never do it with benzos, though they "work" at first. Also, now that the "powers that be" have begun to agree w/ me (I've been saying & doing this for YEARS), touting how the elderly (& all the rest of us) have more falls, more depression, more cognitive impairment w/ these drugs, it's much easier to reason with patients. I know this is a research site -- but it's really difficult to research Common Sense and the Art of Medicine.
Pepi, those of us who do research in healthcare are (hopefully) trying to keep the clinical issues at the forefront! You are absolutely right!
If you create a decision support tool, establish that it could work and is acceptable and feasible for implementation, then there will be stages of promotion and adoption.
You can measure things like awareness of the tool, use (perhaps google anylitics can give you page hit rates etc and number of users), user experience (did it change your practice?),
If you have capability for it, you might promote the tool in one district in which you can track prescriptions or dispensing data and compare to national trends. This would be very difficult to arrange in Australia but completely impossible.
Pepi, completely agree with you and your approach. Bonzos are one of the worst addictions I have encountered and perhaps the worst to get patients off of other than narcotics, among otherwise "normal" patients. It is a long and heart rendering arduous trip to become benzo-free, especially when they seem to" float" around in so many medicine cabinets, prescribed by so many physicians, on demand by patients, for minor life experiences .
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