Evolution of benzodiazepine receptor agonist prescriptions in general practice: A registry-based study

Coteur, Kristien; Mamouris, Pavlos; Vaes, Bert; Nuland, Marc Van; Matheï, Catharina; Schoenmakers, Birgitte

doi:10.3389/fpubh.2022.1014734

Cited by 8 publications

(6 citation statements)

References 49 publications

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“…Data from the latest Health Survey indicate that 12% of Belgians currently use at least one BZRA, with an estimated one in three of those users becoming chronic consumers (Christiaens et al, 2018;Van der Heyden et al, 2020). Despite consecutive prevention campaigns, and an amalgam of guidelines (see Table 1) prescription rates have not dropped over the past decade (Coteur et al, 2022). Clearly, BZRA usage is both substantial and persistent in Belgium.…”

Section: The Double-bind Of Benzodiazepinesmentioning

confidence: 99%

From prescribing dilemma to knowledge in practice: The ontological politics of benzodiazepines and Z-drugs

Ceuterick,

Van Ngoc,

Bracke

et al. 2023

Social Science & Medicine

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Section: The Double-bind Of Benzodiazepinesmentioning

confidence: 99%

From prescribing dilemma to knowledge in practice: The ontological politics of benzodiazepines and Z-drugs

Ceuterick,

Van Ngoc,

Bracke

et al. 2023

Social Science & Medicine

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“…This study has several limitations that must be considered. First, there was some sampling bias in the trial related to the need for basic e-literacy skills because the largest proportion of long-term BZRA users is known to be older adult women [ 34 ]. Therefore, a cautious interpretation of the results is warranted.…”

Section: Discussionmentioning

confidence: 99%

Implementing Blended Care to Discontinue Benzodiazepine Receptor Agonist Use for Insomnia: Process Evaluation of a Pragmatic Cluster Randomized Controlled Trial

Coteur¹,

Nuland²,

Schoenmakers³

et al. 2023

JMIR Form Res

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Background Long-term use of benzodiazepine receptor agonists (BZRAs) remains common despite European guidelines advising that these drugs be used in the lowest possible dose and for the shortest possible duration. Half of all BZRAs are prescribed in family practice. This creates a window of opportunity for discontinuation in primary care. Therefore, the effectiveness of blended care for the discontinuation of long-term BZRA use in adult primary care patients with chronic insomnia disorder was tested in a multicenter, pragmatic, and cluster randomized controlled superiority trial in Belgium. In the literature, information on implementing blended care in a primary care setting is scarce. Objective The study aimed to contribute to a framework for the successful implementation of blended care in a primary care setting by increasing our understanding of this complex intervention through an evaluation of e-tool use and views and ideas of participants in a BZRA discontinuation trial. Methods Based on a theoretical framework, this study evaluated the processes of recruitment, delivery, and response using 4 components: a survey on recruitment (n=76), semistructured in-depth interviews with patients (n=18), web-based asynchronous focus groups with general practitioners (GPs; n=19), and usage data of the web-based tool. Quantitative data were analyzed descriptively, and qualitative data were analyzed thematically. Results For recruitment, the most common barriers were refusal by the patient and the lack of digital literacy, while facilitators were starting the conversation and the curiosity of patients. The delivery of the intervention to the patients was diverse, ranging from GPs who never informed the patient about their access to the e-tool to GPs consulting the e-tool in between consultations to have discussion points when the patient visited. Concerning response, patients’ and GPs’ narratives also showed much variety. For some GPs, daily practice changed because they received more positive reactions than expected and felt empowered to talk more often about BZRA discontinuation. Conversely, some GPs reported no changes in practice or among patients. In general, patients found follow-up by an expert to be the most important component in blended care, whereas GPs deemed the intrinsic motivation of patients to be the key element of success. An important barrier to implementation by the GP was time. Conclusions Overall, the participants who had used the e-tool were positive about its structure and content. Nevertheless, many patients desired a more tailored application with feedback from an expert and personal tapering schedules. Strict pragmatic implementation of blended care seems to only reach GPs with an interest in digitalization. Although not superior to usual care, blended care could be a complementary tool that allows tailoring the discontinuation process to the personal style of the GP and the needs of the patient. Trial Registration ClinicalTrials.gov NCT03937180; https://clinicaltrials.gov/ct2/show/NCT03937180

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“…Our study sample showed to be a realistic patient population, as baseline characteristics were similar to Belgian patients that receive three or more prescriptions for BZRA per year, as documented in Intego, a general practice registration network [ 34 ]. Sex and age characteristics and depression rates were comparable across both samples.…”

Section: Discussionmentioning

confidence: 99%

Blended care to discontinue benzodiazepine receptor agonists use in patients with chronic insomnia disorder: a pragmatic cluster randomized controlled trial in primary care

Coteur

Henrard

Schoenmakers

et al. 2022

Sleep

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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.

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Evolution of benzodiazepine receptor agonist prescriptions in general practice: A registry-based study

Cited by 8 publications

References 49 publications

From prescribing dilemma to knowledge in practice: The ontological politics of benzodiazepines and Z-drugs

From prescribing dilemma to knowledge in practice: The ontological politics of benzodiazepines and Z-drugs

Implementing Blended Care to Discontinue Benzodiazepine Receptor Agonist Use for Insomnia: Process Evaluation of a Pragmatic Cluster Randomized Controlled Trial

Blended care to discontinue benzodiazepine receptor agonists use in patients with chronic insomnia disorder: a pragmatic cluster randomized controlled trial in primary care

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