Table 2 Overview of included studies and interventionsÂ
Study ID | Design | Participants and setting | Description of interventions and control |
|---|---|---|---|
Bashir 1994 [33] | Two-armed randomised controlled trial | 109 patients were recruited from eleven general practices 61.5% female Mean age = 62 years | Intervention group (n = 51): Patients attended consultation with their GP during which they were informed about the risks of benzodiazepines and advised to reduce benzodiazepine intake. The patients were also given a self-help booklet to take home which consisted of basic information about benzodiazepines and practical advice about stopping including techniques to manage fear and anxiety Control (n = 58): No intervention received |
Cormack 1994 [34] | Three-armed randomised controlled trial | 209 patients recruited from three general practices 79.4% female Mean age = 69 years | Intervention group 1 (n = 65): Letter signed by patients GP was sent to patients asking that they reduce or stop benzodiazepine use and advising to do so gradually Intervention group 2 (n = 75): Patients were sent same letter as group 1 as well as four information sheets at monthly intervals which provided practical advice about reducing benzodiazepines and managing without benzodiazepines Control (n = 69): No intervention received |
Heather 2004 [35] | Three-armed randomised controlled trial | 284 patients recruited from seven general practices 74% female Mean age = 69 years (standard deviation = 11.5) | Intervention Group 1 (n = 98): Letter was sent to patients in which they were invited to visit their general practitioner for a medication review. Guidelines were made which provided information for patient about benzodiazepines and the potential benefits of reducing their medication and a timetable to help the patients to plan their dose reduction. Patients also received a self-help booklet and an information sheet about sleeping problems Intervention Group 2 (n = 93): Patients received same letter from their general practitioner advising them to reduce or stop using benzodiazepines and that they should do so gradually. These patients did not receive the self-help booklet or the information leaflet Control (n = 69): No intervention received |
Kuntz 2019 [36] | Three-armed randomised controlled trial | 149 patients who were part of an integrated healthcare delivery system were recruited 66.4% female Mean age = 70 years | Intervention group 1 (n = 50): Letter sent to patients from prescriber in which they were advised to reconsider their Z-drug use. They were also provided with an educational brochure which gave information about the dangers associated with Z-drug use as well as proposals for other treatment options (pharmacological and non-pharmacological). They also received a tapering plan and a self-assessment quiz which reiterated the information from the brochure Intervention group 2 (n = 49): Same intervention as group 1 was given. These patients also received a follow up phone call from a clinical pharmacist two to four weeks after. The pharmacist reinforced the advice from the brochure and discussed obstacles to Z-drug discontinuation. They also provided advice on tapering off Z-drugs and made recommendations about alternatives to Z-drugs (such as sleep medicine). The pharmacist was given prescriber approval to implement a protocol to switch patients to safer medicines for insomnia treatment Control (n = 50): Standard care was provided |
Navy 2018 [37] | Two-armed randomised controlled trial | 364 patients who were members of an integrated healthcare delivery system were recruited 64% female Mean age = 73 years | Intervention group (n = 173): Letter was sent to patients from clinical pharmacist which advised about the risks associated with long-term use of alprazolam. The letter advised patients to call the clinical pharmacist to discuss reducing their alprazolam intake and other potential treatment options. Patients were told to not stop taking alprazolam without first consulting with the clinical pharmacist. The pharmacist worked collaboratively with the patient’s physician to develop an individualised dose reduction plan. The patients progress was monitored by the pharmacist through follow-up telephone calls Control (n = 173): Usual care was provided |
Tannenbaum 2014 [38] | Two-armed cluster randomised controlled trial | 303 patients recruited from 30 community pharmacies which were part of a chain 69% female Mean age = 75 years (standard deviation 6.3) | Intervention group (n = 148): Patients were sent a personalised educational leaflet. The booklet included a self-assessment about the risks associated with benzodiazepine use, information regarding benzodiazepine-induced harms, knowledge statements which were designed to create cognitive dissonance about the safety of benzodiazepine use, information about drug interactions, peer champion stories which aimed to enhance self-efficacy, proposals for therapeutic substitutes for insomnia and anxiety, and step-by-step tapering recommendations with illustrations. The intervention also asked participants to talk to their physician or pharmacist about these benzodiazepine deprescribing recommendations Control (n = 155): Received standard care. Educational intervention was provided 6 months later |
Vicens 2006 [39] | Two-armed randomised controlled trial | 139 patients recruited from three public primary care centres 82% female Mean age = 59 years (standard deviation = 11.4) | Intervention group (n = 73): GPs provided consultation to patients which consisted of a standardised message on the long-term risks of benzodiazepines and information on discontinuing benzodiazepines. Patients underwent gradual reduction of benzodiazepine use with fortnightly dosage reductions of 10–25% Control (n = 66): Usual care provided and the patients were advised about the convenience of reducing their benzodiazepine use |
Vicens 2014 [40] | Three-armed cluster randomised control trial | 532 patients recruited from 21 primary care centres 72% female Median age = 64 (range 55–72) | Intervention group 1 (n = 191): Patients received consultation from their GP and were provided with advice about risks of long-term BZRA use and reassured about reducing their use of their medication. Patients with insomnia were provided with a self-help leaflet regarding improving sleep quality. Patients gradually reduced their dose by 10–25% every 2–3 week at follow up consultations. GPs were allowed to switch patients who were experiencing withdrawal symptoms to long acting benzodiazepines Intervention group 2 (n = 168): Same initial GP consultation provided to patients as in group 1. This was followed by written instructions which reinforced the educational information and included an individually tailored gradual dose reduction plan. There were no follow up interviews scheduled but patients were permitted to request an appointment with their general practitioner if needed Control (n = 173): Patients received standard care |