title: A Pharmacist-Physician Collaboration to Optimize Benzodiazepine Use for Anxiety and Sleep Symptom Control in Primary Care.
abstract: BACKGROUND
  Benzodiazepines are prescribed inappropriately in up to 40% of outpatients. The purpose of this study is to describe a collaborative team-based care model in which clinical pharmacists work with primary care providers (PCPs) to improve the safe use of benzodiazepines for anxiety and sleep disorders and to assess the preliminary results of the impact of the clinical service on patient outcomes.
  
  
  METHODS
  Adult patients were eligible if they received care from the academic primary care clinic, were prescribed a benzodiazepine chronically, and were not pregnant or managed by psychiatry. Outcomes included baseline PCP confidence and knowledge of appropriate benzodiazepine use, patient symptom severity, and medication changes.
  
  
  RESULTS
  Twenty-five of 57 PCPs responded to the survey. PCPs reported greater confidence in diagnosing and treating generalized anxiety and panic disorders than sleep disorder and had variable knowledge of appropriate benzodiazepine prescribing. Twenty-nine patients had at least 1 visit. Over 44 total patient visits, 59% resulted in the addition or optimization of a nonbenzodiazepine medication and 46% resulted in the discontinuation or optimization of a benzodiazepine. Generalized anxiety symptom severity scores significantly improved (-2.0; 95% confidence interval (CI): -3.57 to -0.43).
  
  
  CONCLUSIONS
  Collaborative team-based models that include clinical pharmacists in primary care can assist in optimizing high-risk benzodiazepine use. Although these findings suggest improvements in safe medication use and symptoms, additional studies are needed to confirm these preliminary results.
authors.affiliation: 1 Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA.
authors.forename: Shannon M L
authors.initials: SML
authors.lastname: Furbish
authors.affiliation: 2 Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO, USA.
authors.forename: Miranda E
authors.initials: ME
authors.lastname: Kroehl
authors.affiliation: 3 Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Danielle F
authors.initials: DF
authors.lastname: Loeb
authors.affiliation: 3 Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Huong Mindy
authors.initials: HM
authors.lastname: Lam
authors.affiliation: 3 Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Carmen L
authors.initials: CL
authors.lastname: Lewis
authors.affiliation: 1 Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Nelson
authors.affiliation: 3 Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Zeta
authors.initials: Z
authors.lastname: Chow
authors.affiliation: 1 Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA.|3 Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Katy E
authors.initials: KE
authors.lastname: Trinkley
mesh_terms: D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000188:drug therapy*; D001569:Benzodiazepines / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D000070516:Intersectoral Collaboration; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000592:standards*; D010595:Pharmacists / Q000592:standards*; D010820:Physicians / Q000592:standards*; D011320:Primary Health Care / Q000379:methods / Q000592:standards; D011446:Prospective Studies; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000188:drug therapy*; D011795:Surveys and Questionnaires
chemical_list: D001569:Benzodiazepines
keywords: benzodiazepines; collaborative care; primary care