title: Achieving a sustained reduction in benzodiazepine use through implementation of an area-wide multi-strategic approach.
abstract: OBJECTIVE
  This study aimed to evaluate the impact, in a regional setting, of a multi-strategic partnership approach for reducing benzodiazepine use in the management of insomnia, as recommended in Australia's National Policy on Quality Use of Medicines.
  
  
  METHODS
  The setting was a rural region of South Australia, covering approximately 2000 km2, with a population of over 20 000. The study involved participatory action research, with qualitative and quantitative evaluations. The intervention involved a multi-strategic approach, including provision of treatment guidelines, provision of consumer information, a local media campaign and education and training of health professionals. The quantitative evaluation involved a single region before/after study with 2 years of follow-up using pharmacy-based dispensing data for benzodiazepines and antidepressants, gathered for the months of November to April in 1998/99 ('before' period) through to 2000/01 ('after' period). The data were analysed using non-parametric statistics.
  
  
  RESULTS
  There was a 19% reduction in benzodiazepine dispensing 2 years after the intervention compared with a 6% reduction nationally. Dispensing of antidepressants increased by 33%, compared with a 28% increase nationally.
  
  
  CONCLUSIONS
  It was concluded that the multi-strategic approach to the management of sleep disorders proved successful in promoting the use of non-drug alternatives, achieving sustained reduction in benzodiazepine consumption in a rural community, without therapeutic substitution of antidepressants.
  
  
  CONCLUSIONS
  The study demonstrated that a sustainable reduction in prescribing of benzodiazepines can be achieved through the implementation of a multi-strategic approach involving local consumers, health professionals, a Division of General Practice, a government department, aged-care facilities and the local media.
authors.affiliation: Department of Health, Rundle Mall, SA, Australia. bill.dollman@health.sa.gov.au
authors.forename: W B
authors.initials: WB
authors.lastname: Dollman
authors.forename: V T
authors.initials: VT
authors.lastname: Leblanc
authors.forename: L
authors.initials: L
authors.lastname: Stevens
authors.forename: P J
authors.initials: PJ
authors.lastname: O'connor
authors.forename: E E
authors.initials: EE
authors.lastname: Roughead
authors.forename: A L
authors.initials: AL
authors.lastname: Gilbert
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D001569:Benzodiazepines / Q000009:adverse effects* / Q000627:therapeutic use; D002985:Clinical Protocols; D003256:Community Participation; D003157:Community Pharmacy Services; D004363:Drug Utilization; D006707:Homes for the Aged; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects* / Q000627:therapeutic use; D010595:Pharmacists; D011640:Public Policy; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy*; D013021:South Australia
chemical_list: D000928:Antidepressive Agents; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines