Open Access Highly Accessed Research article

Did the new French pay-for-performance system modify benzodiazepine prescribing practices?

Cédric Rat12*, Gaëlle Penhouet1, Aurélie Gaultier3, Anicet Chaslerie4, Jacques Pivette4, Jean Michel Nguyen23 and Caroline Victorri-Vigneau5

Author Affiliations

1 Department of General Practice, Faculty of Medicine, 1 rue Gaston Veil, 44035 Nantes, France

2 French National Institute of Health and Medical Research (INSERM U892)/National Center for Scientific Research (CNRS U6299), 8 quai Moncousu, 44000 Nantes, France

3 Department of Epidemiology and Biostatistics, Nantes University Hospital, 1 place Alexis Ricordeau, 44000 Nantes, France

4 Medical Department of the French Health Insurance System, 9 rue du Président Edouard Herriot, 44000 Nantes, France

5 Pharmacology Department, Faculty of Medicine, 1 rue Gaston Veil, 44000 Nantes, France

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BMC Health Services Research 2014, 14:301  doi:10.1186/1472-6963-14-301

Published: 11 July 2014



French general practitioners (GPs) were enrolled in a new payment system in January 2012. As part of a national agreement with the French National Ministry of Health, GPs were asked to decrease the proportion of patients who continued their benzodiazepine treatment 12 weeks after its initiation and to decrease the proportion of patients older than 65 who were prescribed long half-life benzodiazepines. In return, GPs could expect an extra payment of up to 490 euros per year. This study reports the evolution of the corresponding prescribing practices of French GPs during that period regarding patients who were prescribed a benzodiazepine for the first time.


The national healthcare system's administrative database was used to report the longitudinal follow-up of two historical cohorts of French patients from the Pays de la Loire area.

Study patients: The “2011” and “2012” cohorts included all patients who initiated benzodiazepine regimens from April 1 to June 30 in 2011 and 2012, respectively.

The primary outcomes were the proportion of those study patients who continued benzodiazepine treatment after 12 weeks and the proportion of study patients >65 years who were prescribed long half-life benzodiazepines.

Analyses were performed using a multi-level regression.


In total, 41,436 and 42,042 patients initiated benzodiazepine treatment in 2011 and 2012, respectively. A total of 18.97% of patients continued treatment for more than 12 weeks in 2012, compared with 18.18% in 2011. In all, 27.43% and 28.06% of patients >65 years continued treatment beyond 12 weeks in 2011 and 2012, respectively. The proportion of patients >65 years who were prescribed long half-life benzodiazepines decreased from 53.5% to 48.8% (p < 0.005) due to an increase in short half-life benzodiazepine prescriptions. Patients >65 years who were prescribed short half-life benzodiazepines were more likely to continue treatment after 12 weeks (p < 0.005).


Despite the pay-for-performance strategy, the number of short half-life benzodiazepine prescriptions increased between 2011 and 2012, and the number of long half-life benzodiazepine initiations remained unchanged. Reducing the proportion of long half-life benzodiazepine prescriptions might be counterproductive because prescribing short half-life benzodiazepines was associated with higher rates of continuation beyond the recommended duration.

Benzodiazepines; Drug prescriptions; Pay-for-performance; Guideline adherence; Family practice; France