Table 2.
Screening and Intervention
| Author/Year/Study Location | Sample Source, Design, Length of Follow up | N | Objective | Measurement | Results | Author’s Conclusion | Relevance for Primary Care | Risk of Bias |
|---|---|---|---|---|---|---|---|---|
| Voyer, et. al 2010, Canada34 | Proportional sample of households based on corresponding administrative regions of Quebec who completed the Quebec Survey on the Health of Senior from Jan 2005–Sept 2006 | N= 2785 adults age ≥ 65 years old who agreed to be in the study | Determine a sample means of detecting benzodiazepine use in the elderly | Assessment based on 12 month period diagnosis according to DSM IV TR criteria for substance dependence Assessment of validity by pairing two criteria together (total of 45 pairs) and examining sensitivity and specificity |
25.4% (707) of the respondents used benzodiazepines and 9.5% of this subgroup met DSM IV criteria for dependence. Of the pairs, “Attempt to stop “ and “Tolerance” had the highest sensitivity and specificity (97.1% and 94.9% respectively) |
Using the two questions as a screening measure could help identify patients with possible benzodiazepine dependence. | This tool may be a good screening measure to use. Further assessment and validation would be required. | This is an international study and as such, the results cannot be generalized to other national populations. Additionally, there is risk of some selection bias as study participants are those who were agreeable to participating. Subjects may also not have given accurate report of use or inaccurately recalled use or attempts to stop. |
| Gugelmann et.al, 2013, United States35 | Patients in two urban EDs who are prescribed opioids from the ED assessed during a Pre-intervention (6–9 months) and Post-intervention (8–11 months) period at 2 tertiary care urban EDs (a primary and affiliate hospital) at different times, Prospective study (Primary Hospital January 2012–August 2012 and affiliate hospital September 2011–August 2012) | N= 40,554 pre-intervention and 30,958 post intervention at the primary hospital N = 18,000 pre-intervention and 27,143 post-intervention at the affiliate hospital At both hospitals, for persons age ≥65, N = 1360 pre-intervention and 852 post-intervention |
To determine if multidisciplinary educational intervention (lectures, journal clubs, case discussions, and EMR decision support tool) would decrease ED opioid packs (4 tablets of Oxycodone 5mg-Acetaminophen 325) dispensed at discharge. | 1. Pre-intervention and post-intervention change in opioid discharge packs dispensed to all patients treated and discharged through August 2012. 2. Analysis of change in opioid dispensing among patients with known risk factors (<65 yo, history of substance abuse, chronic pain or psychiatric disorder) for Rx opioid dependence |
1. Overall discharge packs decreased by 39.6% at primary hospital and 56.2% at the affiliate hospital. 2. For persons age ≥ 65 yo, 210/1360 (15.4%) were given an opioid pack at pre-intervention. 83/852 (9.7%) were given an opioid pack post-intervention. |
Gugelmann et.al, 2013, United States35 | Patients in two urban EDs who are prescribed opioids from the ED assessed during a Pre-intervention (6–9 months) and Post-intervention (8–11 months) period at 2 tertiary care urban EDs (a primary and affiliate hospital) at different times, Prospective study (Primary Hospital January 2012–August 2012 and affiliate hospital September 2011–August 2012) | N= 40,554 pre-intervention and 30,958 post intervention at the primary hospital N = 18,000 pre-intervention and 27,143 post-intervention at the affiliate hospital At both hospitals, for persons age ≥ 65, N = 1360 pre-intervention and 852 post-intervention |