Patient-centered care interventions to reduce the inappropriate prescription and use of benzodiazepines and z-drugs: a systematic review

Abstract

BackgroundBenzodiazepines (BZDs) and z-drugs are effective drugs, but they are prescribed excessively worldwide. International guidelines recommend a maximum treatment duration of 4 weeks. Although these drugs are effective in the short-term, long-term BZD therapy is associated with considerable adverse effects, the development of tolerance and, finally, addiction. However, there are different interventions in terms of patient-centered care that aim to reduce the use of BZDs and z-drugs as well as assist health care professionals (HCPs) in preventing the inappropriate prescription of BZDs.AimThe aim of this systematic review was to identify interventions that promote patient-centered treatments for inappropriate BZD and z-drug use and to analyze their effectiveness in reducing the inappropriate use of these drugs.MethodsTo identify relevant studies, the PubMed, EMBASE, PsycINFO, Psyndex, and Cochrane Library databases were searched. Studies with controlled designs focusing on adult patients were included. Trials with chronically or mentally ill patients were excluded if long-term BZD and z-drug use was indicated. Study extraction was performed based on the Cochrane Form for study extraction. To assess the quality of the studies, we used a tool based on the Cochrane Collaboration’s tool for assessing the risk of bias in randomized trials.ResultsWe identified 7,068 studies and selected 20 for systematic review. Nine interventions focused on patients, nine on HCPs, and two on both patients and HCPs. Intervention types ranged from simple to multifaceted. Patient-centered interventions that provided patient information effectively increased the appropriate use of BZDs. The educational approaches for HCPs that aimed to achieve appropriate prescription reported inconsistent results. The methods that combined informing patients and HCPs led to a significant reduction in BZD use.ConclusionsThis is the first review of studies focused on patient-centered approaches to reducing the inappropriate prescription and use of BZDs and z-drugs. The patient-centered dimension of patient information was responsible for a decrease in BZD and z-drug consumption. Further, in some studies, the patient-centered dimensions responsible for reducing the prescription and use of BZDs and z-drugs were the clinician’s essential characteristics and clinician-patient communication.

Role of the prescriber in supporting patients to discontinue benzodiazepines: a qualitative study

“…As a result, a GP's attitude, skills, and knowledge regarding deprescribing influences the uptake and implementation of these interventions (21,23,24), where hesitation stems from insufficient experience and training rather than a lack of desire to address BZD harm (22,25). A recent review further emphasised the significance of this gap, showing that GP skills and knowledge were central components of patient-centred care, and the patient-centredness of deprescribing interventions underpinned their efficacy (26).…”

“…However, this body of research tends to reflect the experiences of older adults or other specific populations (i.e. highdose dependence) (26,29), and is yet to explore how barriers and facilitators might differ depending on the patients' readiness to change. In other words, the deprescribing conversation is likely very different with someone who has never considered reducing, to that with a patient who raises the concern themselves.…”

The impact of person-centred care on patient safety: An umbrella review of systematic reviews

“…Person-centred care has been positively associated with healthcare quality outcomes (Australian Commission on Safety and Quality in Health Care, 2011, Park et al, 2018, Agency for Healthcare Research and Quality, 2012, Bate and Robert, 2007, Darzi, 2008, Goodrich and Cornwell, 2008, Institute of Medicine, 2001, Rathert et al, 2013. A comprehensive systematic review of 40 studies found that nearly all reported a positive influence of patientcentred processes on patient satisfaction, well-being and self-management.…”

Medicine misuse: A systematic review and proposed hierarchical terminology

“…Of the remaining 172 full texts that were assessed for eligibility, 121 were excluded (see Figure 1 for details of selection process, and Table S2 for details of excluded references). Finally, 51 references were included 3,5–11,13–55 …”