title: Efficacy of two interventions on the discontinuation of benzodiazepines in long-term users: 36-month follow-up of a cluster randomised trial in primary care.
abstract: BACKGROUND
  Primary care interventions that promote cessation of benzodiazepine (BZD) use in long-term users are effective at 1 year, but their efficacy at 3 years is uncertain.
  
  
  OBJECTIVE
  To assess the 3-year efficacy of two primary care interventions delivered by GPs on cessation of BZD use in long-term users.
  
  
  METHODS
  Multicentre, three-arm, cluster randomised, controlled trial, with random allocation at the GP level.
  
  
  METHODS
  Seventy-five GPs and 532 patients were randomly allocated to three groups: usual care (control), structured intervention with stepped-dose reduction and follow-up visits (SIF), or structured intervention with written stepped-dose reduction (SIW). The primary outcome was BZD use at 36 months.
  
  
  RESULTS
  At 36 months, 66/168 patients (39.2%) in the SIW group, 79/191 patients (41.3%) in the SIF group, and 45/173 patients (26.0%) in the control group had discontinued BZD use. The relative risks (RR) adjusted by cluster were 1.51 (95% CI = 1.10 to 2.05; P = 0.009) in the SIW group and 1.59 (95% CI = 1.15 to 2.19; P = 0.005) in the SIF group. A total of 131/188 patients (69.7%) who successfully discontinued BZD use at 12 months remained abstinent at 36 months. The groups showed no significant differences in anxiety, depression, or sleep dissatisfaction at 36 months.
  
  
  CONCLUSIONS
  The interventions were effective on cessation of BZD use; most patients who discontinued at 12 months remained abstinent at 3 years. Discontinuation of BZD use did not have a significant effect on anxiety, depression, or sleep quality.
authors.affiliation: Balearic Health Service - IB-Salut, Son Serra-La Vileta Health Care Centre; Instituto de Investigación Sanitaria de Palma, Palma, Spain.
authors.forename: Caterina
authors.initials: C
authors.lastname: Vicens
authors.affiliation: Valencian Health Service - Conselleria de Sanitat Universal i Salut Pública, Paterna Health Care Centre, Valencia, Spain.
authors.forename: Ermengol
authors.initials: E
authors.lastname: Sempere
authors.affiliation: Catalunya Health Services - Institut Català de la Salut; DAP Camp de Tarragona, Catalunya, Spain.
authors.forename: Ferrán
authors.initials: F
authors.lastname: Bejarano
authors.affiliation: Balearic Health Service - IB-Salut, Manacor Health Care Centre, Manacor, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Socias
authors.affiliation: Balearic Health Service - IB-Salut, Son Serra-La Vileta Health Care Centre; Instituto de Investigación Sanitaria de Palma, Palma, Spain.
authors.forename: Catalina
authors.initials: C
authors.lastname: Mateu
authors.affiliation: Balearic Health Service - IB-Salut, Son Serra-La Vileta Health Care Centre, Palma, Spain.
authors.forename: Francisca
authors.initials: F
authors.lastname: Fiol
authors.affiliation: Valencian Health Service - Conselleria de Sanitat Universal i Salut Pública, La Ribera Hospital, Valencia, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Palop
authors.affiliation: Catalunya Health Services - Institut Català de la Salut; Falset Health Care Centre, Catalunya, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Mengual
authors.affiliation: Catalunya Health Services - Institut Català de la Salut; Constantí Health Care Centre; Catalunya, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Folch
authors.affiliation: Valencian Health Service - Conselleria de Sanitat Universal i Salut Pública, La Ribera Hospital, Valencia, Spain.
authors.forename: Guillem
authors.initials: G
authors.lastname: Lera
authors.affiliation: Catalunya Health Services - Institut Català de la Salut; Reus Health Care Centre, Catalunya, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Basora
authors.affiliation: Primary Care Research Unit of Mallorca, Baleares Health Services - IB-Salut, Palma; Instituto de Investigación Sanitaria de Palma, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Leiva
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000188:drug therapy*; D001569:Benzodiazepines / Q000008:administration & dosage*; D003866:Depressive Disorder / Q000188:drug therapy*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011320:Primary Health Care / Q000379:methods*; D011788:Quality of Life; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000209:etiology / Q000628:therapy*; D013997:Time Factors; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D001569:Benzodiazepines
keywords: adverse effects; benzodiazepine; general practice; primary health care; withdrawal symptoms
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