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Study, Jan/19: In-hospital patient educ'n & attitudes re: benzo deprescription


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The full title of this Australian/Canadian study is "The impact of in hospital patient-education intervention on older people's attitudes and intention to have their benzodiazepines deprescribed: a feasibility study".

 

https://www.ncbi.nlm.nih.gov/pubmed/30728943

 

Abstract

 

Background:

 

Long-term benzodiazepine use in the older population is common and is associated with significant harm. The provision of a patient-educational booklet during hospitalization may encourage patients to discuss review and possible deprescribing of benzodiazepine therapy with their health professionals. The aim of this study was to assess the feasibility and effect of a patient empowerment intervention in hospital inpatients on patient initiation of a discussion about deprescribing benzodiazepines versus usual care.

 

Methods:

 

A feasibility interventional study using a patient-empowerment education intervention was conducted at a Sydney teaching hospital. Patients aged ⩾ 65 years, prescribed a benzodiazepine, and able to provide consent were invited to participate in the study. Participants were randomly allocated to intervention or control group (1:1). Intervention participants received the patient-empowerment booklet and control received usual care. All participants received 1-month follow-up phone interviews to assess medication and attitudinal changes.

 

Results:

 

A total of 42 participants were recruited (20 intervention and 22 control). The average age was 71.5 (interquartile range: 69.0-80.3) and 54.8% were females. There was no difference in baseline characteristics between intervention and control groups (p > 0.05). At baseline, 65.0% of participants (53.0% intervention, 86.0% control) were not concerned about the potential benzodiazepine side effects. Twenty-nine participants (15 intervention and 14 control) completed 1-month follow up; 22 participants (11 intervention and 11 control) were discharged on the benzodiazepine. Among these, 13 (59.1%) had ceased benzodiazepine at 1-month follow up [46.2% (n = 6) intervention; 53.8% (n = 7) control]. In the intervention group, 33.3% (n = 5) of participants had initiated a discussion with their doctor or pharmacist about stopping the benzodiazepine compared with 35.7% (n = 5) in the control group.

 

Conclusion:

 

Cessation of benzodiazepines 1 month following discharge was common. Future larger studies are required to confirm the effectiveness of providing a patient-empowerment booklet on reducing benzodiazepine use and other potentially inappropriate medications.

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I saw this one. What did you think, Lapis?  Not very inspiring especially when you look at the actual numbers. A booklet seems like it might help start a conversation or get patients thinking about the possibility of getting off but it concerns me what information might be included and if it sets an inappropriate expectation as what goes into getting off will be so unique to each person.
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Hi seltzerer,

I didn't read the full study, which is available here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6351969/ . So, I should probably look at that before commenting. I think the booklet is from Dr. Cara Tannenbaum's work here in Canada, and she's one of the founding people behind an organization here that focuses on deprescribing a number of potentially problematic meds (not just benzos) -- in particular, to seniors. I respect her work very much, so as I say, I'd like to have a look at the study before commenting. Dr. Tannenbaum is a geriatrician/researcher.

 

Here's the link to Deprescribing.org, of which she is one of the two leaders. The other is Dr. Barbara Farrell, a pharmacist/researcher:

 

https://deprescribing.org/

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Hi seltzerer,

I think this is the EMPOWER brochure that was used in this study. There's some good information in it, but I don't understand why they use the specific tapering protocol that's suggested. I'd certainly be interested in knowing how they came up with it.

 

http://www.criugm.qc.ca/fichier/pdf/BENZOeng.pdf 

 

Here's another brochure created by the same organization and doctors (Dr. Tannenbaum and Dr. Farrell), where there's no specific tapering plan given -- just some suggestions on tapering slowly with the supervision of one's health care provider:

 

https://deprescribing.org/wp-content/uploads/2018/08/benzodiazepine-deprescribing-information-pamphlet.pdf

 

 

 

 

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Hi seltzerer,

I think this is the EMPOWER brochure that was used in this study. There's some good information in it, but I don't understand why they use the specific tapering protocol that's suggested. I'd certainly be interested in knowing how they came up with it.

 

http://www.criugm.qc.ca/fichier/pdf/BENZOeng.pdf 

 

Here's another brochure created by the same organization and doctors (Dr. Tannenbaum and Dr. Farrell), where there's no specific tapering plan given -- just some suggestions on tapering slowly with the supervision of one's health care provider:

 

https://deprescribing.org/wp-content/uploads/2018/08/benzodiazepine-deprescribing-information-pamphlet.pdf

 

Thanks for posting these, Lapis.

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