Intervention to reduce benzodiazepine prescriptions in primary care, study protocol of a hybrid type 1 cluster randomised controlled trial: the BENZORED study

Abstract

IntroductionBenzodiazepines (BZDs) are mainly used to treat anxiety and sleep disorders, and are often prescribed for long durations, even though prescription guidelines recommend short-term use due to the risk of dependence, cognitive impairment, and falls and fractures. Education of general practitioners (GPs) regarding the prescription of BZDs may reduce the overuse and of these drugs.The aims of this study are to analyse the effectiveness of an intervention targeted to GPs to reduce BZD prescription and evaluate the implementation process.Methods and analysisThe healthcare centres in three regions of Spain (Balearic Islands, Catalonia and Community of Valencia) will be randomly allocated to receive a multifactorial intervention or usual care (control). GPs in the intervention group will receive a 2-hour workshop about best-practice regarding BZD prescription and BZD deprescribing, monthly feedback about their BZD prescribing practices and access to a support web page. Outcome measures for each GP are the defined daily dosage per 1000 inhabitants per day and the proportion of long-term BZD users at 12 months. Data will be collected from the electronic prescription database of the public health system, and will be subjected to intention-to-treat analysis. Implementation will be evaluated by mixed methods following the five domains of the Consolidated Framework For Implementation Research.Ethics and disseminationThis study was approved by the Balearic Islands Ethical Committee of Clinical Research (IB3065/15), l’IDIAP Jordi Gol Ethical Committee of Clinical Research (PI 15/0148) and Valencia Primary Care Ethical Committee of Clinical Research (P16/024). The results will be submitted for publication in peer-reviewed journals.Trial registration number ISRCTN28272199.

Prescribing pattern of benzodiazepines in outpatients without a diagnosis of mental disorders: Retrospective study

“…Brojna istraživanja su pokazala visoku rasprostranjenost hronične upotrebe BZD, što ukazuje na potrebu za proširivanjem znanja porodičnih lekara o metodima koji bi doveli do smanjenja preterane upotrebe ovih lekova 17,18 . Porodični lekari imaju važnu ulogu u smanjenju dugoročne upotrebe BZD.…”

“…Numerous researches showed a high prevalence of chronic use of benzodiazepines, which calls for the need to educate family physicians on methods that would decrease the overuse of these drugs 17,18 . Family physicians play an important role in decreasing the long-term use of benzodiazepines.…”

Deprescribing intervention activities mapped to guiding principles for use in general practice: a scoping review

“…24-28 30 32-37 39 40 42-45 47 48 50-62 64 66 67 69 70 Although this may have occurred as study participant selection, it was included as an activity of deprescribing as GPs need to know which patients to initiate the deprescribing discussions with. GP education occurred in almost half of the studies (n = 24) 25 27 31 35 36 39 41-43 46 53-55 58 61-63 66-68 [70][71][72][73] and was conducted prior to any patient contact and therefore before deprescribing started. GP education was delivered in a variety of ways including workshops, 27 training videos 25 43 and as part of GP medical training.…”

Combatting the misuse of benzodiazepines and related Z drugs in French general practice: a clinical review

“…35 In Spain the analysis of the effectiveness of an intervention targeted to GPs to reduce BZD prescription and evaluate the implementation process has been published. 36…”