title: Analysis of benzodiazepine withdrawal program managed by primary care nurses in Spain.
abstract: BACKGROUND
  Benzodiazepine (BZD), the long-term treatment of which is harmful for cognitive function, is widely prescribed by General Practitioners in Spain. Based on studies performed in other countries we designed a nurse-led BZD withdrawal program adapted to Spanish Primary Care working conditions.
  
  
  RESULTS
  A pseudo-experimental (before-after) study took place in two Primary Care Centres in Barcelona. From a sample of 1150 patients, 79 were identified. They were over 44 years old and had been daily users of BZD for a period exceeding six months. Out of the target group 51 patients agreed to participate. BZD dosage was reduced every 2-4 weeks by 25% of the initial dose with the optional support of Hydroxyzine or Valerian. The rating measurements were: reduction of BZD prescription, demographic variables, the Short-Form Health Survey (SF-12) to measure quality of life, the Medical Outcomes Study (MOS) Sleep Scale, and the Goldberg Depression and Anxiety Scale.By the end of the six-month intervention, 80.4% of the patients had discontinued BZD and 64% maintained abstinence at one year. An improvement in all parameters of the Goldberg scale (p <0.05) and in the mental component of SF-12 at 3.3 points (p = 0.024), as well as in most components of the MOS scale, was observed in the group that had discontinued BZD. No significant differences in these scales before and after the intervention were observed in the group that had not discontinued.
  
  
  CONCLUSIONS
  At one year approximately 2/3 of the patients had ceased taking BZD. They showed an overall improvement in depression and anxiety scales, and in the mental component of the quality of life scale. There was no apparent reduction in the sleep quality indicators in most of the analysed components. Nurses in a Primary Care setting can successfully implement a BZD withdrawal program.
authors.affiliation: Primary Care Center Raval Sud. Institut Català de la Salut, Barcelona 08001, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Lopez-Peig
authors.forename: Xavier
authors.initials: X
authors.lastname: Mundet
authors.forename: Bartomeu
authors.initials: B
authors.lastname: Casabella
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: del Val
authors.forename: David
authors.initials: D
authors.lastname: Lacasta
authors.forename: Eduard
authors.initials: E
authors.lastname: Diogene
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects*; D001007:Anxiety / Q000188:drug therapy* / Q000503:physiopathology; D001569:Benzodiazepines / Q000009:adverse effects*; D003866:Depressive Disorder / Q000188:drug therapy* / Q000503:physiopathology; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006919:Hydroxyzine / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000458:organization & administration*; D010936:Plant Extracts / Q000494:pharmacology / Q000627:therapeutic use; D011320:Primary Health Care; D011788:Quality of Life; D012107:Research Design; D056737:Safety-Based Drug Withdrawals; D012890:Sleep / Q000187:drug effects; D013030:Spain; D011795:Surveys and Questionnaires; D014632:Valerian / Q000737:chemistry
chemical_list: D000928:Antidepressive Agents; D010936:Plant Extracts; D001569:Benzodiazepines; D006919:Hydroxyzine