A Pharmacist–Physician Collaboration to Optimize Benzodiazepine Use for Anxiety and Sleep Symptom Control in Primary Care

Abstract

Introduction Benzodiazepines are prescribed inappropriately in up to 40% of outpatients. The purpose of this study is to describe a collaborative team-based care model in which clinical pharmacists work with primary care providers (PCPs) to improve the safe use of benzodiazepines for anxiety and sleep disorders and to assess the preliminary results of the impact of the clinical service on patient outcomes. Methods Adult patients were eligible if they received care from the academic primary care clinic, were prescribed a benzodiazepine chronically, and were not pregnant or managed by psychiatry. Outcomes included baseline PCP confidence and knowledge of appropriate benzodiazepine use, patient symptom severity, and medication changes. Results Twenty-five of 57 PCPs responded to the survey. PCPs reported greater confidence in diagnosing and treating generalized anxiety and panic disorders than sleep disorder and had variable knowledge of appropriate benzodiazepine prescribing. Twenty-nine patients had at least 1 visit. Over 44 total patient visits, 59% resulted in the addition or optimization of a nonbenzodiazepine medication and 46% resulted in the discontinuation or optimization of a benzodiazepine. Generalized anxiety symptom severity scores significantly improved (–2.0; 95% confidence interval (CI): –3.57 to –0.43). Conclusion Collaborative team-based models that include clinical pharmacists in primary care can assist in optimizing high-risk benzodiazepine use. Although these findings suggest improvements in safe medication use and symptoms, additional studies are needed to confirm these preliminary results.

Long-term use of benzodiazepines and Z drugs: a qualitative study of patients’ and healthcare professionals’ perceptions and possible levers for change

“…24,40 Collaborative team-based models can improve safe medication use and treat the symptoms. 41 Dollman and colleagues' multistrategic approach highlights the benefits of providing medication reduction care to older people, showing a significant reduction in BZD use while successfully promoting new non-medical alternatives. 42 Those concepts could be transferred and integrated into ambulatory care in Germany.…”

Impact of Pharmacists in a Community-Based Home Care Service: A Pilot Program

“…[10][11][12] The literature also supports the positive effects of pharmacy practice in ambulatory care settings, such as decreased benzodiazepine use, improved anxiety scores, improved cardiac outcomes, and improved compliance. [13][14][15] The optimal service delivery model for pharmacists working in home care remains unclear; both home visits and telephonebased practices have been described. [6][7][8]16,17 Home care clinicians in the Winnipeg Regional Health Authority (WRHA) currently rely on community pharmacists for assistance with medicationrelated issues.…”

Primary Care Providers’ Use of Pharmacist Support for Delivery of Pharmacogenetic Testing

“…Pharmacists based on primary care practices currently assist with medication therapy management, polypharmacy and poor medication adherence [30][31][32][33]. Specifically, we assessed the utilization of pharmacist support and its impact on the use of PGx testing during and after the study.…”