Implementation of a discontinuation letter to reduce long-term benzodiazepine use--a cluster randomized trial.
BACKGROUND
Although it is recommended to restrict long-term use of benzodiazepines, and considerable attention has been paid to this, long-term use continues to be a problem. An informative discontinuation letter for patients has been shown to reduce long-term benzodiazepine use in general practice. However, little is known about its wide scale implementation in primary care.


OBJECTIVE
To determine the effectiveness of an intensive support programme for community pharmacies to send discontinuation letters to patients in cooperation with GPs.


METHODS
In a cluster randomized trial, 43 control pharmacies received a written manual and 47 experimental pharmacies received an intensive support programme. Primary outcome measures were the percentage of GPs who reviewed and returned lists of eligible patients and the percentage of long-term users who were sent a discontinuation letter within 4 months.


RESULTS
The outcomes did not differ for the experimental versus control groups: 38% and 31% of the GPs, respectively, returned the patient lists; 14% and 10% of all long-term users in the two groups, respectively, received the discontinuation letter within 4 months. Substantially more pharmacies in the experimental group than in the control group finally managed to send discontinuation letters (70% vs. 40%).


CONCLUSIONS
About one third of the pharmacies in the control group and two thirds of the pharmacies in the intervention group finally implemented the discontinuation letter. However, this difference was not apparent in the primary outcome measures. It seems crucial to involve GPs more effectively in implementation of the discontinuation letter.
van de Steeg-van Gompel
Caroline H P A
CH
Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. cvandesteeg@live.nl
Wensing
Michel
M
De Smet
Peter A G M
PA
D001569:Benzodiazepines / Q000009:adverse effects*; D003157:Community Pharmacy Services; D005194:Family Practice; D005500:Follow-Up Studies; D006801:Humans; D009426:Netherlands; D010353:Patient Education as Topic; D010594:Pharmacies; D010595:Pharmacists; D011897:Random Allocation; D018401:Sample Size; D016896:Treatment Outcome
D001569:Benzodiazepines