A controlled trial of educational visiting to improve benzodiazepine prescribing in general practice

Burgh, Simon de; Mant, Andrea; Mattick, Richard P.; Donnelly, Neil; Hall, Wayne; Bridges‐Webb, C

doi:10.1111/j.1753-6405.1995.tb00364.x

Cited by 35 publications

(23 citation statements)

References 25 publications

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“…When compared to control, 50% of the educational interventions targeted at GPs had significant decreased benzodiazepine use and 17% (1 study, [29]) which did not reduce overall use of benzodiazepines did significantly decrease the number of new patients being prescribed benzodiazepines.…”

Section: Resultsmentioning

confidence: 99%

Improving the use of benzodiazepines-Is it possible? A non-systematic review of interventions tried in the last 20 years

Smith

Tett

2010

BMC Health Serv Res

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BackgroundBenzodiazepines are often used on a long term basis in the elderly to treat various psychological disorders including sleep disorders, some neurological disorders and anxiety. This is despite the risk of dependence, cognitive impairment, and falls and fractures. Guidelines, campaigns and prescribing restrictions have been used to raise awareness of potentially inappropriate use, however long term use of benzodiazepine and related compounds is currently increasing in Australia and worldwide. The objective of this paper is to explore interventions aimed at improving the prescribing and use of benzodiazepines in the last 20 years.MethodsMedline, EMBASE, PsychINFO, IPA were searched for the period 1987 to June 2007.ResultsThirty-two articles met the study eligibility criteria (interventions solely focusing on increasing appropriate prescribing and reducing long term use of benzodiazepines) and were appraised. Insufficient data were presented in these studies for systematic data aggregation and synthesis, hence critical appraisal was used to tabulate the studies and draw empirical conclusions. Three major intervention approaches were identified; education, audit and feedback, and alerts.ConclusionsStudies which used a multi-faceted approach had the largest and most sustained reductions in benzodiazepines use. It appears that support groups for patients, non-voluntary recruitment of GPs, and oral delivery of alerts or feedback may all improve the outcomes of interventions. The choice of outcome measures, delivery style of educational messages, and requests by GPs to stop benzodiazepines, either in a letter or face to face, showed no differences on the success rates of the intervention.

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Section: Resultsmentioning

confidence: 99%

Improving the use of benzodiazepines-Is it possible? A non-systematic review of interventions tried in the last 20 years

Smith

Tett

2010

BMC Health Serv Res

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“…Twelve studies were excluded for the following reasons: intervention targeted at pharmacists, study protocol without results or incomplete methods description, or observational study design without a control group. The systematic review includes 15 studies: 11 RCTs and 4 observational studies [7,[19][20][21][22][23][24][25][26][27][28][29][30][31][32].…”

Section: Study Selectionmentioning

confidence: 99%

“…De Burgh et al evaluated the effect of AD on reducing benzodiazepines (BDZ) prescriptions for insomnia and anxiety [22] by comparing the rate of BDZ prescriptions per 100 patient encounters with diagnoses of anxiety or insomnia. The overall rate of BDZ prescriptions decreased by 23.7% between pre and post-intervention surveys (p < 0.001) in the entire study sample, but no statistically significant differences were observed between AD and controls (p = 0.2) in overall BDZ prescription rates or in prescription of BDZ for either anxiety or insomnia.…”

Section: Description Of Studiesmentioning

confidence: 99%

Effectiveness of Academic Detailing to Optimize Medication Prescribing Behaviour of Family Physicians

et al. 2013

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PURPOSE. To synthesize current knowledge about the effectiveness and the magnitude of the effect, of Academic Detailing (AD), as a stand-alone intervention, at modifying drug prescription behavior of Family Physicians (FPs) in primary care settings. METHODS. A search of MEDLINE, EMBASE, CENTRAL, and Web of Science databases of all English language articles between January 1983 and July 2010 was conducted. We hand-searched the bibliographies of articles retrieved from the electronic search to identify additional studies. Inclusion criteria were: full-length articles describing original research; randomized controlled trial (RCT), or observational study design with a control group; studies of AD delivered to FPs; AD as a stand-alone intervention; drug prescription as the target behavior. Data extraction was done independently by two reviewers. Outcomes evaluated were: the difference in relative change in prescription rate between the intervention and control groups; the difference in absolute change in prescription rate between the intervention and control groups; and effect size, calculated as the standardized mean difference. RESULTS. 11 RCTs and 4 observational studies were included. Five RCTS described results showing effectiveness, while 2 RCTs reported a positive effect on some of the target drugs. Two observational studies found AD to be effective, while 2 did not. The median difference in relative change among the studies reviewed was 21% (interquartile range 43.75%) for RCTs, and 9% (interquartile range 8.5%) for observational studies. The median effect size among the studies reviewed was -0.09 (interquartile range 2.73). CONCLUSION. This systematic review demonstrates that AD can be effective at optimizing prescription of medications by FPs. Although variable, the magnitude of the effect is moderate in the majority of studies. This systematic review also provides evidence supportive of the use of AD as a strategy to promote evidence based prescription of medications or incorporation of clinical guidelines into clinical practice.

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“…For example, the state of New York implemented a triplicate prescription monitoring program that resulted in a decline in prescribing of BZDs by half [39]. Studies have evaluated educational visits to doctors to discuss alternative treatments for sleep disorders [40], and electronic medical record systems have implemented alerts and reminders to encourage prescription of safer medication alternatives [41]. Educational materials targeted at patients have also provided information on proper sleep hygiene [42].…”

Section: Discussionmentioning

confidence: 99%

Emergency department visits involving benzodiazepines and non-benzodiazepine receptor agonists

Kaufmann

Spira

Alexander

et al. 2017

The American Journal of Emergency Medicine

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Objective Sedative-hypnotic medications (e.g., Benzodiazepines [BZDs] and non-benzodiazepine receptor agonists [nBZRAs]) are associated with adverse events, especially in the elderly, that may require emergency department (ED) treatment. This study assessed outcomes from ED visits attributed to BZDs and/or nBZRAs, and variations in these associations by age group. Methods Data came from the 2004–2011 waves of the Drug Abuse Warning Network (DAWN). Visits were categorized as involving: (1) BZDs-only, (2) nBZRAs-only, (3) combination of BZDs and nBZRAs, or (4) any other sedative-hypnotic medication. DAWN also recorded the disposition (i.e., outcome) of the visit. Analyses focused on outcomes indicating a serious disposition defined as hospitalization, patient transfer or death. Using logistic regression, the association of BZD and nBZRA use with visit disposition was assessed after applying sample weights so as to be nationally representative of ED visits in the United States involving medications or illicit substances. Results Nineteen percent of visits involving other sedative-hypnotics, 28% involving BZDs-only, 20% involving nBZRAs-only and 48% involving a combination of BZDs and nBZRAs resulted in a serious disposition. Compared to visits involving other sedative-hypnotics, visits involving BZDs-only had 66% greater odds (Odds Ratio [OR]=1.66, 95% Confidence Interval [CI]=1.37–2.01), and visits involving a combination of BZDs and nBZRAs had almost four times increased odds of a serious disposition (OR=3.91, 95% CI=2.38–6.41). Results were similar across age groups. Conclusions Findings highlight the need for clinical and regulatory initiatives to reduce BZD use, especially in combination with nBZRAs, and to promote treatment with safer alternatives to these medications.

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A controlled trial of educational visiting to improve benzodiazepine prescribing in general practice

Cited by 35 publications

References 25 publications

Improving the use of benzodiazepines-Is it possible? A non-systematic review of interventions tried in the last 20 years

Improving the use of benzodiazepines-Is it possible? A non-systematic review of interventions tried in the last 20 years

Effectiveness of Academic Detailing to Optimize Medication Prescribing Behaviour of Family Physicians

Emergency department visits involving benzodiazepines and non-benzodiazepine receptor agonists

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