title: Minimal interventions to decrease long-term use of benzodiazepines in primary care: a systematic review and meta-analysis.
abstract: BACKGROUND
  Long-term use of benzodiazepines (BZDs) is common. Not only is such use ineffective, but it also has several risks in addition to dependence, and remains a significant problem among the older population.
  
  
  OBJECTIVE
  To systematically review randomised controlled trials that evaluate the effectiveness of minimal interventions to reduce the long-term use of BZDs in primary care.
  
  
  METHODS
  Systematic review and meta-analysis of randomised controlled trials in UK general practices.
  
  
  METHODS
  Cochrane Central, MEDLINE, and Embase (1967-2010) were searched for trials of minimal interventions (such as a single letter or one consultation from a GP) for patients in primary care with long-term (>3 months) BZD use. Pooled risk differences were calculated with 95% confidence intervals.
  
  
  RESULTS
  From 646 potentially relevant abstracts, three studies (615 patients) met all the inclusion criteria. The pooled risk ratio showed a significant reduction/cessation in BZD consumption in the minimal intervention groups compared to usual care (risk ratio [RR] = 2.04, 95% confidence interval [CI] = 1.5 to 2.8, [corrected] P<0.001; RR = 2.4, 95% CI = 1.3 to 4.3, P = 0.008) respectively. Two studies also reported a significant proportional reduction in consumption of BZD from baseline to 6 months in intervention groups compared to the control group. The secondary outcome of general health status was measured in two studies; both showed a significant improvement in the intervention group.
  
  
  CONCLUSIONS
  A brief intervention in the form of either a letter or a single consultation by GPs, for long-term users of BZD, is an effective and efficient strategy to decrease or stop their medication, without causing adverse consequences.
authors.affiliation: Bond University, Gold Coast, QLD, Australia. kmugunth@bond.edu.au
authors.forename: Kayalvili
authors.initials: K
authors.lastname: Mugunthan
authors.forename: Treasure
authors.initials: T
authors.lastname: McGuire
authors.forename: Paul
authors.initials: P
authors.lastname: Glasziou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000188:drug therapy*; D001569:Benzodiazepines / Q000627:therapeutic use*; D003142:Communication; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D016032:Randomized Controlled Trials as Topic; D012017:Referral and Consultation; D012307:Risk Factors; D006113:United Kingdom; D055815:Young Adult
chemical_list: D001569:Benzodiazepines