General Practitioners reduced benzodiazepine prescriptions in an intervention study: a multilevel application

An educational intervention to reduce the use of potentially inappropriate medications among older adults (EMPOWER study): protocol for a cluster randomized trial

“…Interventions to reduce benzodiazepine use in older people have been tested [24-47]. Several approaches have yielded insignificant results; other approaches, such as physician-targeted online drug audits, didactic educational activities and letters from physicians advising on risks associated with benzodiazepine use, have resulted in discontinuation rates ranging from 16 to 25% [43-47].…”

Multilevel Interventions: Study Design and Analysis Issues

“…One can intervene to affect health behaviors at several levels, such as individuals (1)(2)(3)(4), groups (1), families (5), schools (5), worksites (6), religious organizations (7), health-care plans or organizations, physicians or clinics (2,3,(8)(9)(10)(11)(12), and neighborhoods (4) or communities (1,(12)(13)(14)(15)(16)(17). Many health researchers are interested in developing, implementing, and evaluating multilevel interventions (1,3,5,(18)(19)(20) because they believe that we are most likely to achieve substantial and sustained change with interventions based on ecological theory that target multiple levels, or sources of influence (6,18,(21)(22)(23)(24).…”

“…Many health researchers are interested in developing, implementing, and evaluating multilevel interventions (1,3,5,(18)(19)(20) because they believe that we are most likely to achieve substantial and sustained change with interventions based on ecological theory that target multiple levels, or sources of influence (6,18,(21)(22)(23)(24). The expectation for a multilevel intervention usually is that that the combined effect of the interventions used will at least be additive, which is the sum of the effects of what the interventions would have achieved separately.…”

Knowing How to Stop: Ceasing Prescribing When the Medicine Is No Longer Required

“…7 We found only 12 relevant, highquality, experimental or quasi-experimental studies among 1,306 articles that we reviewed. [8][9][10][11][12][13][14][15][16][17][18][19] The review suggested that it is possible to stop a variety of medications through a range of interventions, including manual 10,16 and electronic reminders, 18 audit and feedback, 12,15 distribution of educational materials, 9,15,16 clinical pharmacist intervention, 8 and regulatory intervention. 19 However, the reviewed studies were highly heterogeneous in study design, patient characteristics, prescription settings, method of measuring prescribing, tests of intervention effects, and method of determining prescribing cessation.…”

“…19 However, the reviewed studies were highly heterogeneous in study design, patient characteristics, prescription settings, method of measuring prescribing, tests of intervention effects, and method of determining prescribing cessation. Often studies did not directly measure the occurrence of prescribing cessation and instead inferred cessation from changes in mean numbers of medications 12,15 or dosages, 12 prescribed daily doses 11 or defined daily doses, 17 and changes in drug-use patterns. 19 A key finding of our review into the limited prescribing cessation research to date is that both consumer (patient) and doctor buy-in is needed to successfully cease the prescribing of a medicine.…”