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. 2021 Jul 23;56(4):463–474. doi: 10.1177/10600280211033022

Table 3.

Studies Evaluating Interventions to Overcome Health System Constraints to Reduce SH Use by Community-Dwelling Adults.

Study description Intervention Results NNT
Subcategory: government level
Jørgensen (2007) 48
• Design: uncontrolled pre-post
• Duration: 15 months
• Setting: 10 Danish medical practices with 13 medical practitioners and 18 500 patients
• Target: BZD, Z-drugs
• New government restrictions for BZDs, hypnotics, anxiolytics and Z-drugs. Limit maximum supply of a single prescription for up to 30-day supply, and only following consultation
• Telephone prescriptions were not permitted
• Public awareness campaign (local press, newspapers, educational posters, meetings, staff guides, patient guides)
• Postintervention, Z-drug prescriptions were reduced by 50.5%, BZD hypnotics by 46.5%, and BZD anxiolytics by 41.7% (no difference between drug classes [P = 0.30])
• During first 3 months, only 4.3 additional consultations per week per 1000 patients were required, which then reduced to 2.1
N/A
Hooper et al (2009) 49
• Design: before-and-after
• Duration: 8.5 years
• Setting: registered medical practitioners in 3 major regions of Tasmania, Australia
• Targeted: BZD (alprazolam)
• Pharmacies required to report all alprazolam prescriptions to the government monitoring agency monthly
• Application for authorization if prescribing for ≥4 weeks to patients coprescribed an opiate
• Physicians were notified to not prescribe alprazolam to patients currently receiving BZD and/or opioids from another medical practitioner. Patients on methadone or buprenorphine were required to have approval to receive an alprazolam prescription
• Educational sessions (n = 3) on evidence-based interventions for panic disorder provided by psychiatrists, pharmacists, and addiction medicine specialists. Education topics: diagnosis of panic disorder, evidence for BZD use in panic disorder, issue of BZD abuse among opiate users, and forthcoming regulatory changes
• 26% GPs attended educational sessions
• Alprazolam prescriptions decreased from 19 228 in the preintervention period to 16 261 in the postintervention period (relative reduction 15.4%)
• In the rest of Australia, prescriptions for alprazolam increased by 1.3% in this same period
• The number of individuals receiving both alprazolam and opioid prescriptions declined linearly in this time period [patients = −6.3 (month) + 246.1; R2 = 0.59; t(11) = 4.0 (P < 0.01)]
N/A
Schaffer et al (2016) 50 and Lloyd et al (2017) 51
• Design: interrupted time series analysis
• Duration: 6 years
• Setting: 10% sample of Australian prescription data
• Target: alprazolam
• In 2014, alprazolam was selectively “up-scheduled” to be a controlled drug in an attempt to curb prescribing
• Pharmacies had to submit a monthly report to the government for all alprazolam prescriptions dispensed
• Prescribers had to apply for authority to prescribe if prescribing for ≥4 weeks
• Alprazolam use reduced by ~33% (95% CI = −36.3% to −30.1%) vs the 12 months prior to change in schedule
• Unintended consequences: (1) switching to another BZD increased 214%; (2) BZD overdoses increased from 380 in 2013 to 453 in 2015
N/A
Subcategory: local level
Larkin et al (2017) 52
• Design: controlled pre-post
• Duration: 6 years
• Setting: 38 AMCs in 5 US states
• Target: multiple drugs
• AMCs with pharmaceutical detailing policies (includes any policies addressing gifts, access to AMC staff and enforcement) compared to AMCs without policies
• Multiple drug classes were studied
• Mean change in SH prescriptions (predominantly BZDs and Z-drugs) following detailing policy was decrease of 10.5% (95% CI = −18.87 to −2.16; P = 0.01) compared to an increase of 4.7% (95% CI = 0.81-8.50) in the control group N/A

Abbreviations: AMC, academic medical centers; BZD, benzodiazepine; GP, general practitioner; N/A, not applicable; NNT, number needed to treat; SH, sedative-hypnotics; Z-drugs, zopiclone, zolpidem.