Supporting safe and gradual reduction of long‐term benzodiazepine receptor agonist use: Development of the SAFEGUARDING‐BZRAs toolkit using a codesign approach

Abstract

Introduction: Long-term benzodiazepine receptor agonist (BZRA) use persists in healthcare settings worldwide and poses risks of patient harm. Objective: This study aimed to develop an intervention to support discontinuation of long-term BZRA use among willing individuals. Methods: The intervention development process aligned with the UK Medical Research Council's complex intervention framework. This involved a previous systematic review of brief interventions targeting long-term BZRA use in primary care and qualitative interviews based on the Theoretical Domains Framework that explored barriers and facilitators to discontinuing long-term BZRA use. A codesign approach was used involving an active partnership between experts by experience, researchers and clinicians. Intervention content was specified in terms of behaviour change techniques (BCTs). Results: The SAFEGUARDING-BZRAs (Supporting sAFE and GradUAl ReDuctIon of loNG-term BenZodiazepine Receptor Agonist uSe) toolkit comprises 24 BCTs and includes recommendations targeted at primary care-based clinicians for operationalizing each BCT to support individuals with BZRA discontinuation. Conclusion: The SAFEGUARDING-BZRAs toolkit has been developed using a systematic and theory-based approach that addresses identified limitations of previous research. Further research is needed to assess its usability and acceptability by service users and clinicians, as well as its potential to effectively support safe and gradual reduction of long-term BZRA use. Patient or Public Contribution: The qualitative interview phase included patients as participants. The codesign process included 'experts by experience' with either current or previous experience of long-term BZRA use as collaborators.

‘We need more support and doctors that understand the process of tapering …’: A content analysis of free‐text responses to a questionnaire on discontinuing long‐term benzodiazepine receptor agonist use

“…A number of respondents also stated that forced discontinuation and withdrawal of BZRA use should also be banned, with some noting the importance for individuals to be supported to taper at their own pace. This is congruent with the approach recommended by the SAFEGUARDING‐BZRAs toolkit, whereby the co‐design team involved in its development do not encourage, or support, forced withdrawal or discontinuation of long‐term BZRA use 9 . It also aligns with recent guidelines from the National Institute for Health and Care Excellence on safe prescribing of medicines associated with dependence or withdrawal symptoms, such as BZRAs 34 .…”

“…This is congruent with the approach recommended by the SAFEGUARDING-BZRAs toolkit, whereby the co-design team involved in its development do not encourage, or support, forced withdrawal or discontinuation of long-term BZRA use. 9 It also aligns with recent guidelines from the National Institute for Health and Care…”

“…This is congruent with the approach recommended by the SAFEGUARDING‐BZRAs toolkit, whereby the co‐design team involved in its development do not encourage, or support, forced withdrawal or discontinuation of long‐term BZRA use. 9 It also aligns with recent guidelines from the National Institute for Health and Care Excellence on safe prescribing of medicines associated with dependence or withdrawal symptoms, such as BZRAs. 34 Finally, a small number of respondents noted that the medication provided benefit at one point.…”

“…7 As part of a multiphase research project, a theory-based intervention was developed to support discontinuation of longterm BZRA use in primary care. 8,9 The SAFEGUARDING-BZRAs (Supporting sAFE and GradUAl ReDuctIon of loNG-term BenZodiazepine Receptor Agonist uSe) toolkit is underpinned by the theoretical domains framework (TDF), an integrated framework of 33 behaviour change theories that comprises domains that are considered mediators (i.e., barriers, facilitators) of behaviour change. 10 The SAFEGUARDING-BZRAs toolkit comprises 24 behaviour change techniques (BCTs) that map to individual domains within the TDF.…”

Development and validation of a theory-based questionnaire examining barriers and facilitators to discontinuing long-term benzodiazepine receptor agonist use

“…A multiphase intervention development project was undertaken targeting the discontinuation of long-term BZRA use in primary care 8,9 . The intervention development approach followed the UK Medical Research Council's guidance 10 and was underpinned by the Theoretical Domains Framework (TDF) which is an integrated framework of 33 behaviour change theories.…”