Table 3.
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.