Pharmacy-based “patient empowerment” plan aids benzodiazepine cessation
Source: (Belahoche/ Dreamstime.com)
A pharmacy-based patient education programme in Canada has shown success in reducing benzodiazepine use by the elderly, the results of a randomised trial reported in JAMA Internal Medicine (online, 14 April 2014) suggest.
Over six-months, the “patient empowerment intervention” evaluated in the EMPOWER (eliminating medications through patient ownership of end results) trial led to benzodiazepine discontinuation in more than one-quarter of patients and a dose reduction in a further 10 per cent.
“In an era of multimorbidity, polypharmacy and costly therapeutic competition, direct-to-consumer education is emerging as a promising strategy to stem potential overtreatment and reduce the risk of drug harms,” write the study authors, who were led by Cara Tannenbaum from the University of Montreal, Quebec, Canada.
A total of 303 long-term benzodiazepine users aged 65–95 years were recruited via 30 community pharmacies in greater Montreal, which were randomly assigned to the intervention or control arm. The intervention involved a personalised eight-page booklet about the risks of benzodiazepine use together with a drug tapering protocol and advice for the patient to discuss “deprescribing” with their doctor or pharmacist, or both. The pack was posted to participants. Those in the control arm received usual care.
The most frequent indications for benzodiazepine use were insomnia and anxiety; participants had used benzodiazepines for a mean of 10 years and had an average daily dose of 1.3mg lorazepam equivalents.
Complete cessation of benzodiazepines occurred in 27.0 per cent of patients assigned to the intervention and 4.5 per cent of controls. This difference was statistically significant (P=0.008) with an adjusted odds ratio of 8.33 and a number needed to treat (NNT) of 4.35.
An additional 11 per cent of patients who received the intervention reduced their drug dose and the NNT to achieve discontinuation or dose reduction was 3.70.
In telephone follow-up interviews, 62 per cent of patients in the intervention group said they had initiated discussions about benzodiazepine discontinuation with their doctor or pharmacist, or both, and 58 per cent had attempted discontinuation. Pharmacists were solicited less often than doctors to discuss benzodiazepine therapy discontinuation, the researchers note (4.0 per cent versus 35.8 per cent of participants). Nearly all participants said they were satisfied with receiving information about medication risks.
Dr Tannenbaum and co-authors remark: “With the expanding scope of pharmacists’ practice and an increasing emphasis on interprofessional models of care, community pharmacists may be underutilised players to participate in efforts to reduce costly and unnecessary medical treatments.”
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.11137793
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