Predictors of discontinuation of benzodiazepine prescription after sending a letter to long-term benzodiazepine users in family practice.
BACKGROUND
Predictors of benzodiazepine discontinuation after sending a discontinuation letter by the family practitioner have not been established sufficiently.


OBJECTIVE
To identify predictors of short- and long-term discontinuation of benzodiazepine use and relapse in use after a minimal intervention with a discontinuation letter followed by an offer for an evaluation consultation.


METHODS
Predictors of benzodiazepine discontinuation and relapse in use were studied by logistic regression analysis and survival analysis within a family practice population of long-term benzodiazepine users (n = 1707) addressed by a discontinuation letter and followed for 21 months.


RESULTS
A lower baseline prescription, a shorter duration of use, male gender and use of an agent with a half-life time <24 hours were predictive of complete discontinuation in the short (6 months) and long term (21 months). Multiple agent use at baseline, use of antidepressants at 6 months and benzodiazepine type (anxiolytic/hypnotic) at baseline predicted relapse. Attendance at an evaluation consultation 3 months after the letter was sent was not predictive of discontinuation or relapse.


CONCLUSIONS
Amount of baseline use and duration of use are the main determinative characteristics of successful discontinuation. The discontinuation letter intervention is suitable for use with a broad group of long-term benzodiazepine users in family practice and can be used as a first step within a stepped care approach to decrease long-term benzodiazepine use.
Gorgels
W J M J
WJ
Department of Psychiatry, Leiden University Medical Center, The Netherlands. W.Gorgels@hag.umcn.nl
Oude Voshaar
R C
RC
Mol
A J J
AJ
van de Lisdonk
E H
EH
van Balkom
A J L M
AJ
Breteler
M H M
MH
van den Hoogen
H J M
HJ
Mulder
J
J
Zitman
F G
FG
D000328:Adult; D000368:Aged; D014151:Anti-Anxiety Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001291:Attitude of Health Personnel; D001569:Benzodiazepines / Q000008:administration & dosage* / Q000009:adverse effects; D015709:Correspondence as Topic; D004334:Drug Administration Schedule; D011307:Drug Prescriptions; D004363:Drug Utilization; D005194:Family Practice / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019966:Substance-Related Disorders / Q000517:prevention & control
D014151:Anti-Anxiety Agents; D001569:Benzodiazepines