چکیده (انگلیسی):

Background:The prevalence of multimorbidity is increasing worldwide, presumably leading to an increased use of
medicines. During the last decades the use of hypnotic and anxiolytic benzodiazepine derivatives and related drugs has
increased dramatically. These drugs are frequently prescribed for people with a sleep disorder often merely designated as
“insomnia”in the medical records and lacking a clear connection with the roots of the patients’ problems. Our aim was to
analyse the prevalence of multimorbidity in primary healthcare in Iceland, while concurrently investigating a possible
association with the prevalence and incidence of hypnotic/anxiolytic prescriptions, short-term versus chronic use.
Methods:Data were retrieved from a comprehensive database of medical records from primary healthcare in Iceland
to find multimorbid patients and prescriptions for hypnotics and anxiolytics, linking diagnoses (ICD-10) and prescriptions
(2009–2012) to examine a possible association. Nearly 222,000 patients, 83 % being local residents in the capital area, who
contacted 16 healthcare centres served in total by 140 general practitioners, were set as a reference to find the
prevalence of multimorbidity as well as the prevalence and incidence of hypnotic/anxiolytic prescriptions.
Results:The prevalence of multimorbidity in the primary care population was 35 %, lowest in the young, increasing with
age up to the 80+ group where it dropped somewhat. The prevalence of hypnotic/anxiolytic prescriptions was 13.9 %.
The incidence rate was 19.4 per 1000 persons per year in 2011,and 85 % of the patients prescribed hypnotics/anxiolytics
were multimorbid. Compared to patients without multimorbidity, multimorbid patients were far more likely to be
prescribed a hypnotic and/or an anxiolytic, OR = 14.9 (95 % CI = 14.4–15.4).
Conclusions:Patients with multiple chronic conditions are common in the primary care setting, and prevalence and
incidence of hypnotic/anxiolytic prescriptions are high. Solely explaining use of these drugs by linear thinking, i.e. that
“insomnia”leads to their prescription is probably simplistic, since the majority of patients prescribed these drugs are
multimorbidhavingseveralchronicconditionswhichcouldleadtosleepingproblems.However,multimorbidityassuch
is not an indication for hypnotics, and doctors should be urged to greater caution in their prescribing, bearing in mind
non-pharmacological therapy options.