Brian A. Primack, MD, PhD
Can minimal interventions reduce or stop long-term use of benzodiazepines (BZDs) in adults in primary care?
Included studies assessed minimal interventions (i.e., a letter, self-help information, or short consultation with a general practitioner that addressed concerns about long-term use of hypnotics, particularly potential side effects, and included practical advice on how to gradually and safely reduce or stop BZDs) in patients > 18 years of age who had been taking BZDs for > 3 months. Primary outcomes were reduction and cessation of BZD use.
MEDLINE, EMBASE/Excerpta Medica, and Cochrane Central Register of Controlled Trials (all to Aug 2010), and reference lists of identified studies and reviews were searched for randomized controlled trials (RCTs). 3 RCTs (n = 615, mean age > 60 y, > 60% women) involving 5 comparisons with control (continued usual dose) met inclusion criteria. Minimal interventions assessed were a letter (2 comparisons), letter plus follow-up (1 comparison), and letter plus consultation (2 comparisons). 2 trials had adequate randomization methods, and all had objective outcome measures (prescription records).
Meta-analysis showed that patients allocated to minimal interventions reduced and stopped BZD use more often than those allocated to control (Table).
Such minimal interventions as a letter, with or without a single consultation with a general practitioner, reduces or stops long-term use of benzodiazepines in primary care patients.
*Abbreviations defined in Glossary. RBI, NNT, and CI calculated from event rates and risk ratios in article using a random-effects model. Analyses based on 5 comparisons (n = 588).
Brian A. Primack. Review: Minimal interventions (e.g., a letter) reduce long-term benzodiazepine use in primary care. Ann Intern Med. 2012;156:JC2–8. doi: 10.7326/0003-4819-156-4-201202210-02008
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Published: Ann Intern Med. 2012;156(4):JC2-8.
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