| Avorn et al. (1992) |
A randomized trial of a program to reduce the use of psychoactive drugs in nursing home |
USA |
RCT |
Nursing home |
5 months |
823 |
Long-time users of psychoactive drugs and BZDs, not reported intervention group of 6 nursing homes (431) control group of 6 nursing homes (392) |
Educational program to improve medical competence based on the principles of “academic detailing,” which focuses on direct patient care, alternatives to psychoactive drugs and recognition of adverse drug reactions face-to-face educational sessions by clinical pharmacists for prescribers and written information material for prescribers |
Essential characteristics of the clinician and clinician-patient communication |
Significant reduce psychoactive drug use in experimental group than in control (27% vs. 8%, p = 0.02). The comparable figures for the discontinuation of long-acting benzodiazepines were 20% vs. 9% (no significant) |
| Batty et al. (2001) |
Investigating intervention strategies to increase the appropriate use of benzodiazepines in elderly medical in-patients |
UK |
RCT |
Hospitals |
6–12 months |
1,414 |
Inappropriate BZDs users, M = 75 years, not reported verbal intervention (not reported) bulletin intervention (not reported) control group (not reported) |
Verbal intervention delivered in an interactive lecture format by a physician and a pharmacist to an audience arranged by the hospital contact. Bulletin intervention involved dissemination of printed material to physicians, pharmacist and nurses involved in the care at the hospital |
Essential characteristics of the clinician and clinician-patient communication |
Appropriate prescribing following verbal intervention increased substantially from 29% to 44% but this did not achieve statistical significance. There was a reduction in appropriate prescribing following bulletin intervention (42–33%) and no change following control intervention (42–42%) |
| Berings, Blondeel & Habraken (1994) |
The effect of industry-independent drug information on the prescribing of benzodiazepines in general practice |
Belgium |
RCT |
General practices |
4 weeks |
128 |
General practitioners, not reported oral and written information (44) written information (43) no information (41) |
Educational mail arguing for the rational and short-term prescribing of benzodiazepines, contained specific information regarding the limited effectiveness of long-term benzodiazepine use, risks and different forms of habituation and dependence supported by an independent medical representative whose oral message was congruent with the written materials and who answered any questions |
Essential characteristics of the clinician |
The absolute reduction in the number of prescribed packages was highest in condition one (oral and written information) with a mean decrease of 24% compared to the baseline. A reduction of 14% was found in physicians of condition two (written information) and of 3% in the control group |
| Midlöv et al. (2006) |
Effects of educational outreach visits on prescribing of benzodiazepines and antipsychotic drugs to elderly patients in primary health care in southern Sweden |
Sweden |
RCT |
General practices |
12 months |
54 |
Physicians in general practices, not reported (not reported) intervention group (23) control group (31) |
Physician’s and pharmacist’s visits in 2–8 week intervals: the first visit dealt with different causes of confusion in the elderly like medications, infections and other illnesses while discussing associated literature, whereas the second visit focused on the effects and risks of benzodiazepine use with medium or long acting duration of medication action |
Essential characteristics of the clinician |
One year after the educational outreach visits there were significant decreases in the active group compared to control group in the prescribing of medium- and long-acting BZDs and total BZDs but not so for antipsychotic drugs |
| Pimlott et al. (2003) |
Educating physicians to reduce benzodiazepine use by elderly patients: a randomized controlled trial |
Canada |
RCT |
General practices |
12 months |
374 |
General practitioners, M = 50.6/50.7 years, not reported intervention group (168) control group (206) |
Feedback packages were mailed that presented bar graphs comparing the prescriber with his or her peers and a hypothetical “best practice” supported by evidence-based educational material |
Essential characteristics of the clinician |
Although the proportion of long-acting benzodiazepine prescriptions decreased by 0.7% in the intervention group between the baseline period and the end of the intervention period (from 20.3%, or a mean of 29.5 prescriptions, to 19.6%, or a mean of 27.7 prescriptions) and increased by 1.1% in the control group (from 19.8%, or a mean of 26.4 prescriptions, to 20.9%, or a mean of 27.7 prescriptions) (p = 0.036), this difference was not clinically significant |
| Pit et al. (2007) |
A Quality Use of Medicines program for general practitioners and older people: a cluster randomized controlled trial |
Australia |
RCT |
General practices |
12 months |
20 physicians |
n = 20 general practitioners in 16 practices with n = 849 patients, older than 65 years intervention group (397) control group (352) |
Educational sessions by pharmacists explaining how to conduct medication reviews with emphasis on benzodiazepines, accompanied by written sources of information on prescribing medication; risk assessment contained 31 items assessing risk factors for medication misadventure |
Essential characteristics of the clinician |
Compared with the control group, participants in the intervention group had increased odds of having an improved medication use composite score (odds ratio [OR], 1.86; 95% CI, 1.21–2.85) at 4-month follow-up but not at 12 months |
| Roberts et al. (2001) |
Outcomes of a randomized controlled trial of a clinical pharmacy intervention in 52 nursing homes |
Australia |
RCT |
Nursing homes |
12 months |
52 nursing homes |
52 nursing homes with n = 3.230 patients, not reported intervention group of 13 nursing homes (905) control group of 39 nursing homes (2 325) |
Clinical pharmacy service model based on issues such as drug policy and specific resident problems, together with education and medication review and problem-based educational sessions for nurses addressing basic geriatric pharmacology and some common problems in long-term care medication; review by pharmacists highlighting the potential for adverse drug effects, ceasing one or more drug therapy, non-drug intervention and adverse effect and drug response monitoring |
Essential characteristics of the clinician |
This intervention resulted in a reduction in drug use with no change in morbidity indices or survival. The use of benzodiazepines was significantly reduced in the intervention group. Overall, drug use in the intervention group was reduced by 14.8% relative to the controls |
| Smith et al. (1998) |
A randomized controlled trial of a drug use review intervention for sedative hypnotic medications |
USA |
RCT |
Medicaid recipients (outpatients) |
6 months |
189 |
BZDs users, 55 years and older, 61–63% women intervention group (99) control group (89) |
Written information consisted of: a letter describing the drug use and education council guidelines for sedative hypnotic prescribing; a prescriber-specific profile about sedative hypnotic prescribing; a patient profile for each of the prescribers patients identified as over utilizers |
Essential characteristics of the clinician |
The intervention achieved a statistically significant decrease in targeted drug use, and the amount of reduction is likely to have decreased the risk of fractures associated with benzodiazepine use |
| Smith & Tett (2010) |
An intervention to improve benzodiazepine use—a new approach |
Australia |
CT |
General practices (outpatients) |
6 months |
429 physicians |
429 physicians intervention group (not reported) control group (not reported) |
Information emails consisted of educational facts relating to benzodiazepines, including information on common side effects, indications, precautions and recommendations regarding prescribing as well as characteristics and alternative non-drug techniques; the website contained links to Australian Department of Health and Ageing websites which provided consumer information on medicines including sleeping tablets |
Essential characteristics of the clinician |
A significantly smaller number of aged care residents were on benzodiazepines for 6 months or more (p < 0.05) after the intervention compared with before |
