Comparative efficacy of two interventions to discontinue long-term benzodiazepine use: cluster randomised controlled trial in primary care

BACKGROUND:

Benzodiazepines are extensively used in primary care, but their long-term use is associated with adverse health outcomes and dependence.

AIMS:

To analyse the efficacy of two structured interventions in primary care to enable patients to discontinue long-term benzodiazepine use.

METHOD:

A multicentre three-arm cluster randomised controlled trial was conducted, with randomisation at general practitioner level (trial registration ISRCTN13024375). A total of 532 patients taking benzodiazepines for at least 6 months participated. After all patients were included, general practitioners were randomly allocated (1:1:1) to usual care, a structured intervention with follow-up visits (SIF) or a structured intervention with written instructions (SIW). The primary end-point was the last month self-declared benzodiazepine discontinuation confirmed by prescription claims at 12 months.

RESULTS:

At 12 months, 76 of 168 (45%) patients in the SIW group and 86 of 191 (45%) in the SIF group had discontinued benzodiazepine use compared with 26 of 173 (15%) in the control group. After adjusting by cluster, the relative risks for benzodiazepine discontinuation were 3.01 (95% CI 2.03-4.46, P<0.0001) in the SIW and 3.00 (95% CI 2.04-4.40, P<0.0001) in the SIF group. The most frequently reported withdrawal symptoms were insomnia, anxiety and irritability.

CONCLUSIONS:

Both interventions led to significant reductions in long-term benzodiazepine use in patients without severe comorbidity. A structured intervention with a written individualised stepped-dose reduction is less time-consuming and as effective in primary care as a more complex intervention involving follow-up visits.

 

HuisartsengeneeskundeOverigEducational gatheringsEducational literature distributionsBehandeling medicatieBelemmerende en bevorderende factor

 

Auteurs

Vicens C
Bejarano F
Sempere E
Mateu C
Fiol F
Socias I
Aragonès E
Palop V
Beltran JL
Piñol JL
Lera G
Folch S
Mengual M
Basora J
Esteva M
Llobera J
Roca M
Gili M
Leiva A

 

Link

https://www.ncbi.nlm.nih.gov/pubmed/24526745