| Bashir, King & Ashworth (1994) |
Controlled evaluation of brief intervention by general practitioners to reduce chronic use of benzodiazepines |
UK |
CT |
General practices |
6 |
109 |
Chronic BZDs users, M = 62 years, 61% women intervention group (51) control group (58) |
A self-help booklet included general information about benzodiazepine and techniques of coping with fears and anxiety supported with physician’s advice |
Patient information |
Eighteen percent of patients in the intervention group (9/50) had a reduction in benzodiazepine prescribing recorded in the notes compared with 5% of the 55 patients in the control group (p < 0.05) |
| Cormack et al. (1994) |
Evaluation of an easy, cost-effective strategy for cutting benzodiazepine use in general practice |
UK |
CT |
General practices |
6 |
209 |
Long-term regular users of BZDs, M = 69 years, 4:1 women to men letter group (65) letter plus advice group (75) control group (69) |
Discontinuation letter asked the patient to reduce or stop the medication gradually and provide information about reducing medication and practical suggestions for nonpharmacological coping strategies plus 4-monthly information sheets |
Patient information |
After 6 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 groups. 18% of those receiving the interventions received no prescriptions at all during the 6 month monitoring period |
| Gorgels et al. (2005) |
Discontinuation of long-term benzodiazepine use by sending a letter to users in family practice: a prospective controlled intervention study |
Nether-lands |
CT |
Family practices |
6–21 |
4,416 |
Long-term BZDs users, M = 68 years, 65–69% women experimental group (2,595) control group (1,821) |
Patient information as a discontinuation letter advised to gradually stop benzodiazepine use supported with patient-physician-communication, which evaluated actual benzodiazepine use |
Patient information |
At 6 months a large reduction in benzodiazepine prescription was present of 24% in the experimental group, vs. 5% in the control group. At 21 months again a steady reduction in benzodiazepine prescription of 26% was observed in the experimental group, vs. 9% in the control group, indicating that the short-term gain of the intervention was preserved |
| Tannenbaum et al. (2014) |
Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: The EMPOWER Cluster |
Canada |
RCT |
Community pharmacies |
6 |
303 |
Long-term BZDs users, M = 75 years, 69% women intervention group (138) control group (155) |
Patient information via a personalized booklet comprising a self-assessment component including risks and advice about drug interactions and mentioning evidence, tapering recommendations and therapeutic substitutes as well as knowledge statements and peer champion theories to create cognitive dissonance about the safety of the benzodiazepine intake and augment self-efficacy |
Patient information |
At 6 months, 27% of the intervention group had discontinued benzodiazepine use compared with 5% of the control group (risk difference, 23% [95%CI, 14–32%]; intracluster correlation, 0.008; number needed to treat, 4). Dose reduction occurred in an additional 11% (95%CI, 6–16%) |
| Ten Wolde et al. (2008) |
Long-term effectiveness of computer-generated tailored patient education on benzodiazepines: a randomized controlled trial |
Netherlands |
RCT |
General practices |
12 |
695 |
Chronic BZDs users, M = 62.3 years, 68.1 women single tailored letter (163) multiple tailored letter (186) general practitioner letter (159) |
Patient information either via two individual tailored letters aiming to reduce the positive outcome expectation of benzodiazepines by bearing in mind benefits of its withdrawal and in this case increasing self-efficacy expectations or a short general practitioner letter that modelled usual care |
Patient information |
Among participants with the intention to discontinue usage at baseline, both tailored interventions led to high percentages of those who actually discontinued usage (single tailored intervention 51.7%; multiple tailored intervention 35.6%; general practitioner letter 14.5%) |
| Stewart et al. (2007) |
General practitioners reduced benzodiazepine prescriptions in an intervention study: a multilevel application |
Netherlands |
CT |
General practices |
12 |
8,179 |
Chronic BZDs users, M = 64.63 years, 73.2% women intervention group (19 general practices) control group (128 general practices) |
Patient information as a discontinuation letter outlined information about the risks of continuous use of benzodiazepines and recommended their withdrawal by inviting patients to an appointment to discuss this procedure, followed by an information leaflet about BZDs |
Patient information and clinician-patient communication |
Sending a letter to chronic long-term users of benzodiazepines advising decreasing or stopping benzodiazepine use in general practice resulted in a 16% reduction after 6 months and a 14% reduction after 1 year |
| Heather et al. (2004) |
Randomized controlled trial of two brief interventions against long-term benzodiazepine use: outcome of intervention |
UK |
RCT |
General practices |
6 |
284 |
Long-term BZDs users, M = 69.1 years, 48% females letter group (93) consultation group (98) control group (93) |
Patient information via self-help booklet included information about tranquilizers, sleeping tablets and their withdrawal accompanied by a leaflet about sleeping problems and a discontinuation letter which informed about risks and advised to stop the intake, supported with patient-physician-communication including general information about benzodiazepines as well as advantages of and guidelines for withdrawal |
Patient information and clinician-patient communication |
Results showed significantly larger reductions in BZDS consumption in the letter (24% overall) and consultation (22%) groups than the control group (16%) but no significant difference between the two interventions |
| Vicens et al. (2006) |
Withdrawal from long-term benzodiazepine use: randomized trial in family practice |
Spain |
RCT |
Public primary care centers |
12 |
139 |
Long-term BZDs users, M = 59 years, 82% women intervention group (73)control group (66) |
Patient information via physicians’ interview given on the first and follow up visits: first visit concentrated mostly on general information about benzodiazepines and their risks/effects, while the follow up visits focused on positive reinforcement of achievements |
Patient information and clinician-patient communication |
After 12 months, 33 (45.2%) patients in the intervention group and six (9.1%) in the control group had discontinued benzodiazepine use; relative risk = 4.97 (95% confidence interval [CI] = 2.2–11.1), absolute risk reduction = 0.36 (95% CI = 0.22–0.50). Sixteen (21.9%) subjects from the intervention group and 11 (16.7%) controls reduced their initial dose by more than 50% |
| Vicens et al. (2014) |
Comparative efficacy of two interventions to discontinue long-term benzodiazepine use: cluster randomized controlled trial in primary care |
Spain |
RCT |
General practices |
12 |
532 |
Long-term BZDs users, M = 64 years, 72% women structured intervention (SIF) (191) structured intervention with written instructions (SIW) (168) control group (173) |
Educational intervention for patients with fortnightly follow-up visits to support gradual tapering (SIF) and written information material for patients rather than follow-up visits (SIW); patient information via educational interview included an information on benzodiazepine dependence, abstinence and withdrawal symptoms, risks of long-term use and reassurance about reducing medication as well as a self-help leaflet to improve sleep quality |
Patient information, clinician-patient communication and essential characteristics of the clinician |
At 12 months, 76 of 168 (45%) patients in the SIW group and 86 of 191 (45%) in the SIF group had discontinued benzodiazepine use compared with 26 of 173 (15%) in the control group. Both interventions led to significant reductions in long-term benzodiazepine use in patients without severe comorbidity |
