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Since thc late 1970s there has been a marked decline in the prescribing of the benzodiazepines. Yet long-term use of this drug persists despite widespread media condemnation and growing professional concern. The study seeks to illuminate this phenomenon by deploying qualitative methods to investigate the meaning that such medication has for the users themselves and their styles of management, tn-depth interviews were conducted with fifteen community-based users and seven members of a self-help group. From this material a typology was developed that reflected the relationship users had formed with their medication. The key dimensions in this typology were the degree of dependency on the drug, the perceived level of risk associated with it, and underlying attitude. The relationships to the drug reflected in the typology were suggestive of a pattern of self-regulation and active management by users, rather than dominance and control by practitioners. Furthermore, the investigation indicated that characteristics of the medication regime itself- such as type of drug and dose exert an influence on the attribution of meaning and the place of the drug in users' lives. While a characterisation of patient subculture has real potential for application in clinical practice, there are also implications within medical sociology for theories of medicalisation and social control. [ABSTRACT FROM AUTHOR]

Background/Objectives: To determine the effect of a proactive primary care program on acute hospitalization and aged‐residential care placement for frail older people. Design: Controlled before and after, and controlled after only quasi‐experimental studies, with a comparison group created via propensity score matching. One‐year follow‐up. Setting: Nine general practices in Auckland, New Zealand. Participants: Community‐dwelling people aged 75 and older identified as at increased risk of hospitalization. One thousand and eighty five patients are compared with 3750 comparison patients matched by propensity score based on known risks. Intervention: Primary healthcare based, registered nurse‐led, comprehensive geriatric assessment, goal‐setting, care planning, and regular follow‐up. Patients were also provided self‐management education, health and social care navigation, and transitional care for hospital discharges. Practices received program support, workforce development, and mentoring of primary healthcare nurses by gerontology nurse specialists. Measurements: Outcomes from routinely collected administrative data. Primary: aged‐residential care placement. Secondary outcomes: acute hospitalization, mortality, and other health service utilization. Results: Aged‐residential care placement (odds ratio [OR] 0.66, 95% confidence interval (CI) = 0.48‐0.91) and mortality (OR 0.66, 95% CI = 0.49–0.88) were significantly lower over the first year in Kare patients compared with matched controls. There was no difference in acute hospitalization (+0.06 admissions per year, 95% CI = −0.01–0.13). Support service use (allied health therapists and assessment for social support) was increased, and emergency department use decreased. Conclusion: The Kare participants had lower aged‐residential care placement and mortality in the first year, but no decrease in acute hospitalization. Because the design is nonexperimental caution is required in interpreting these results. See related editorial by Danto‐Nocton et al. and article by Moreno et al. in this issue. [ABSTRACT FROM AUTHOR]