Evaluation of an easy, cost-effective strategy for cutting benzodiazepine use in general practice.

AIM: This study set out to assess the effect of a letter from the general practitioner, suggesting a reduction in the use of benzodiazepines, and whether the impact of the letter could be increased by the addition of information on how to tackle drug reduction. METHOD: Two hundred and nine long-term users of benzodiazepines in general practice were divided into three groups: two intervention groups and a control group. The first intervention group received a letter from their general practitioner asking that benzodiazepine use be gradually reduced and perhaps, in time, stopped. The second intervention group received the same letter plus four information sheets at monthly intervals, designed to assist drug reduction: The mean age of the 209 people was 69 years (age range 34-102 years). RESULTS: After six months, both intervention groups had reduced their consumption to approximately two thirds of the original intake of benzodiazepines and there was a statistically significant difference between the intervention groups and the control group. Eighteen per cent of those receiving the interventions received no prescriptions at all during the six month monitoring period. CONCLUSION: The results indicate that a simple intervention can have a considerable effect on the use of hypnotic and anxiolytic drugs, even with a sample of elderly users.

Factors linked to the prescribing of benzodiazepines by general practice principals and trainees.

Principals and trainees in general practice attending training events were asked to give information about their prescribing of drugs, with a focus on the prescribing of benzodiazepines for psychological problems. High prescribers of benzodiazepines believed that a prescription saved consultation time, tended to be influenced by drug company information and believed that patients expected a prescription. Low prescribers of benzodiazepines did not prescribe for bereavement, wished to have more psychological expertise and offered treatments other than drugs. Doctors classified as empathic from their statements at interview found difficulty in ending consultations and thought that social problems should be part of the general practitioner's work, although there were no differences between empathic and unsympathetic doctors in overall prescribing rates of benzodiazepines. The data suggest that doctors who are emphatic towards their patients would prescribe less if they had training in psychological skills.

The effect of minimal interventions by general practitioners on long-term benzodiazepine use.

Seventy one long-term users of benzodiazepines were asked by their general practitioners in a letter or short interview to reduce their medication. Twenty two patients were successful in giving up or reducing their consumption to less than 100 tablets per annum. There were no clear predictors of success in terms of patient characteristics, duration of drug use, type of benzodiazepine, reason for drug use or strategy employed to reduce medication. However, patients who were successful at reducing their medication had a significantly lower mean baseline drug consumption than unsuccessful patients. The implications of this study are that a proportion of long-term users who are not in current crisis, especially those with relatively low consumption, can reduce or stop benzodiazepine treatment with minimal difficulty.

Psychological alternatives to long-term benzodiazepine use.

The aim of the study was to evaluate the effectiveness of psychological management of anxiety as an alternative to long-term benzodiazepine medication. Fifty patients were identified who had been taking benzodiazepines continuously for at least one year. No significant differences were found between patients who joined a treatment group and patients who were simply advised by letter to cut down their pills. Patients gave a variety of reasons for initially requiring medication and somewhat different reasons for needing to maintain chemotherapy, which suggested that pill-taking might be self-maintaining through withdrawal symptoms.