Reduction of Inappropriate Benzodiazepine Prescriptions Among Older Adults Through Direct Patient Education

Abstract

Campaign recommends against the use of benzodiazepine drugs for adults 65 years and older. The effect of direct patient education to catalyze collaborative care for reducing inappropriate prescriptions remains unknown. OBJECTIVE To compare the effect of a direct-to-consumer educational intervention against usual care on benzodiazepine therapy discontinuation in community-dwelling older adults. DESIGN, SETTING, AND PARTICIPANTS Cluster randomized trial (EMPOWER [Eliminating Medications Through Patient Ownership of End Results] study [2010-2012, 6-month follow-up]). Community pharmacies were randomly allocated to the intervention or control arm in nonstratified, blocked groups of 4. Participants (303 long-term users of benzodiazepine medication aged 65-95 years, recruited from 30 community pharmacies) were screened and enrolled prior to randomization: 15 pharmacies randomized to the educational intervention included 148 participants and 15 pharmacies randomized to the "wait list" control included 155 participants. Participants, physicians, pharmacists, and evaluators were blinded to outcome assessment. INTERVENTIONS The active arm received a deprescribing patient empowerment intervention describing the risks of benzodiazepine use and a stepwise tapering protocol. The control arm received usual care. MAIN OUTCOMES AND MEASURES Benzodiazepine therapy discontinuation at 6 months after randomization, ascertained by pharmacy medication renewal profiles. RESULTS A total of 261 participants (86%) completed the 6-month follow-up. Of the recipients in the intervention group, 62% initiated conversation about benzodiazepine therapy cessation with a physician and/or pharmacist. At 6 months, 27% of the intervention group had discontinued benzodiazepine use compared with 5% of the control group (risk difference, 23% [95% CI, 14%-32%]; intracluster correlation, 0.008; number needed to treat, 4). Dose reduction occurred in an additional 11% (95% CI, 6%-16%). In multivariate subanalyses, age greater than 80 years, sex, duration of use, indication for use, dose, previous attempt to taper, and concomitant polypharmacy (10 drugs or more per day) did not have a significant interaction effect with benzodiazepine therapy discontinuation. CONCLUSIONS AND RELEVANCE Direct-to-consumer education effectively elicits shared decision making around the overuse of medications that increase the risk of harm in older adults. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01148186

Beliefs and attitudes of older adults and carers about deprescribing of medications: a qualitative focus group study

“…Also, the preferences of those with mild dementia (who have been shown to be able to express preferences for treatment 43,44 ) need to be studied. Future research should focus on the development of a guide to assist GPs in discussing medication discontinuation with older adults and their carers as well as continued efforts towards education and patient-directed deprescribing interventions (which have shown some effectiveness 45,46 ). In addition, the role of pharmacists and nurses in deprescribing needs to be further explored to facilitate deprescribing in practice.…”

Mortality Risk of Hypnotics: Strengths and Limits of Evidence

“…Such studies have now become ethically obligatory. Apart from the classic double-blind randomized drug administration trial, there are interesting new ethical approaches to randomly modifying hypnotic consumption among large groups of patients [59], though such an approach would seem difficult to implement double-blind. Unfortunately, clinical medicine may wait a long time before any investigator finds a sponsor for such a study unless the regulatory authorities take their responsibility to protect the public seriously enough to insist that manufacturers perform adequate mortality-risk studies.…”

The third global patient safety challenge: tackling medication-related harm

“…Progress has been made in identifying medication history and drug-drug combinations that are particularly problematic, enabling risk-stratification and risk-reduction approaches through, for example, de-prescribing initiatives in Canada 7 and the United States of America. 8 However, these initiatives are only addressing a part of the problem of polypharmacy.…”