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Summary Study Objectives International guidelines recommend using benzodiazepine receptor agonists (BZRA) for maximally four weeks. Nevertheless, long-term use for chronic insomnia disorder remains a common practice. This study aimed to test the effectiveness of blended care for discontinuing long-term BZRA use in general practice. Methods A pragmatic cluster randomized controlled superiority trial compared blended care to usual care through urine toxicology screening. In the intervention, care by the general practitioner (GP) was complemented by an interactive e-learning program, based on cognitive behavioral therapy for insomnia. Adults using BZRA daily for minimally six months were eligible. Participants were clustered at the level of the GP surgery for allocation (1:1). Effectiveness was measured as the proportion of patients who had discontinued at one-year follow-up. Data analysis followed intention-to-treat principles. Results In total, 916 patients in 86 clusters, represented by 99 GPs, were randomized. Primary outcome data was obtained from 727 patients (79%). At one-year follow-up, 82 patients (18%) in blended care, compared to 91 patients (20%) in usual care, had discontinued. There was no statistically significant effect for the intervention (OR: 0·924; 95% CI: 0·60, 1·43). No adverse events were reported to the research team. Conclusions The findings did not support the superiority of blended care over usual care. Both strategies showed clinical effectiveness, with an average of 19% of patients having discontinued at one-year follow-up. Further research is important to study the effect of structurally implementing digital interventions in general practice.

BackgroundContrary to most European guidelines, benzodiazepine receptor agonists (BZRA) are often used continuously at a low dosage, being the most common form of long-term use. In Belgium, BZRA use is monitored by analyzing self-report data about medication use in the last 24 h. This method provides insufficient insight into the terms of use of these psychoactive drugs.AimTo describe trends in BZRA prescribing in Flanders, Belgium, between 2000 and 2019.Design and settingPopulation-based trend analysis and a case-control study for the year 2019 were done with data from a morbidity registry in general practice.MethodsRepeated cross-sectional and joinpoint regression analyses revealed trends in sex- and age-standardized prescription rates among adult patients (18+).ResultsOverall, BZRA prescriptions increased. The highest overall increase was found among male patients 18–44 years old, with an average annual percentage change of 2.5 (95% CI: 0.9, 4.3). Among 65+ female patients, a decrease was found since 2006, with an annual percentage change of −0.7 (95% CI: −1.3, −0.1). In 2019, 12% of registered patients received minimally one prescription, long-term use was observed in 5%, back pain was the most common morbidity significantly associated with a rise in BZRA prescriptions, and zolpidem was the most prescribed BZRA (22%).ConclusionDespite some statistically significant decreasing trends, an overall increase in BZRA prescriptions was observed throughout the 19-year study period, especially among long-term users of 18–44 years and 65-plus. Zolpidem became the most prescribed BZRA and warrants more attention.

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Background: The COVID-19 pandemic has profoundly affected assessment practice in higher education including a complex planning of supervision. To organise safely and reliably a remote proficiency-test for admission to the Advanced Master of General Practice (AMGP), we developed a supervisor app tracking and tracing candidates’ behaviour. Methods: A cross-sectional design was adopted with candidates applying for admission to the AMGP. The supervisor app operated on three levels to register events: recording actions, analysing behaviour, and live supervision. Each suspicious event was given a score. The outcome measures were the number of suspicious events and the exam outcome compared to the past year. To get more insight into candidates’ perceptions about the app, a post-test questionnaire was administered. An exploratory factor analysis was performed to explore quantitative data, while qualitative data were thematically analysed. Results: In total, 472 (79%) candidates used the app in an off campus setting and 121 (20%) were on campus with live supervision. Test results of both groups were comparable. The app detected 22 candidates with a suspicious level >1, mainly due to background noise. All events occurred without fraud purpose. Out of 472 candidates, 304 filled in the post-test questionnaire. Two factors were extracted from the analysis and identified as candidates’ appreciation of the app and as emotional distress because of the app. Four themes were identified in the thematic analysis providing more insight on candidates’ emotional well-being. Conclusions: A supervisor app registering and recording behaviour to prevent fraud during off-campus exams is efficient without influencing the exam outcome. Although candidates’ perceptions were mixed, increased anxiety was due to the lack of clear guidelines about the app. Future research should compare in a controlled design the cost-benefit balance between the supervisor app and candidates’ awareness of being monitored combined with a safe exam browsing plug in.

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