减少苯二氮卓类药物过度使用的多学科干预的长期有效性：一项集群对照试验。

IF 3.7 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Research in Social & Administrative Pharmacy Pub Date : 2025-03-22 DOI:10.1016/j.sapharm.2025.03.063

Ingrid Ferrer López , Encarnación García Bermúdez , Francisco Atienza Martín , Amalia García-Delgado Morente , María Dolores Murillo Fernández , Yolanda Sánchez Cañete , Clara Bermúdez-Tamayo

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引用次数: 0

摘要

背景：苯二氮卓类药物（BZD）的过度使用已成为一个令人关注的领域，因为它对患者的健康和医疗保健费用的后果。目的：确定与常规治疗相比，基于多学科教育计划的多组分干预是否对BZD长期使用的戒断有效。方法：以健康中心为随机化单位，以患者为分析单位的整群随机、平行组试验。纳入标准：使用BZD超过4周的成年人，无严重精神障碍，非终末期，无酒精依赖或痴呆。干预：(i)与患者讨论BZD使用的优点，缺点和替代方案，并附有教育材料的逐渐减少方案，（ii）提供简短的咨询，（iii）由6个科学协会支持的致患者的信。主要结果是BZD的分配。与BZD消费相关的社会经济变量和其他变量（指征，先前试图停止使用和持续时间）。分析：利用logistic回归的多变量广义估计方程（GEE）扩展分析了干预对BZD配药率的影响。结果：干预6个月后，333名参与者中有108人（32.4%）完全停止配药BZD，而139名对照组中有27人（19.4%）。这种下降持续了5年（41.7% vs. 33.8%）。调整后的绝对风险差为-14.3（-19.6至-9.5）。调整后OR为2.11 （95% CI, 1.24-3.59）。与低收入者相比，高收入者更有可能在干预后停止使用BZD （OR 1.81, IC 95% 1.13-2.9, p = 0.012）。同样地，那些先前试图从BZD中退出的人更有可能在干预后停止使用（OR 1.8, IC 95% 1.17-2.8, p = 0.007）。与低收入者相比，高收入者更有可能在干预后停止使用BZD （OR 1.81, IC 95% 1.13-2.9, p = 0.012）。同样地，那些先前试图从BZD中退出的人更有可能在干预后停止使用（OR 1.8, IC 95% 1.17-2.8, p = 0.007）。结论：干预6个月有效，效果持续5年。有利于中断BZD的因素似乎是有高收入和以前试图退出BZD。

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Effectiveness at long-term of a multidisciplinary intervention in the reduction of overuse of benzodiazepine prescriptions: A cluster controlled trial

Background

The overuse of Benzodiazepines (BZD) has become an area of concern because of its consequences on patients' health and healthcare costs.

Objective: to determine whether a multicomponent intervention based on a multidisciplinary education program is effective in withdrawal from BZD long-term use, compared to usual care.

Methods

Cluster-randomized, parallel-group trial with health centres as units of randomization and patients as units of analysis. Inclusion criteria: adults with more than 4 weeks of BZD use, without serious mental disorder, non-terminal, without alcohol dependence or dementia. Intervention: (i) discussion with the patient describing the advantages, disadvantages and alternatives of BZD use accompanied by tapering protocol with educational material, (ii) the offer of a brief consultation, and (iii) a letter addressed to the patient supported by 6 scientific societies. The primary outcome was dispensing of BZD. Socioeconomic variables and others related with the consumption of BZD (Indication, previously attempted to cease and duration of use). Analysis: The effect of the intervention on the rate of dispensing of BZD using the multivariable generalized-estimating-equations (GEE) extension of logistic regression.

Results

Complete cessation of dispensing BZD at six months after the intervention was achieved in 108 of 333 participants (32,4 %) compared to 27 of 139 controls (19,4 %). This decrease was maintained over 5 years (41,7 % vs. 33,8 %). Adjusted absolute risk difference was −14.3 (−19.6 to −9.5). An adjusted OR 2.11 (95 % CI, 1.24–3.59). Those with high income were more likely to quit using BZD with the intervention as those with a lower income (OR 1.81, IC 95 % 1.13–2.9, p = 0.012). Similarly, those who had previously tried to withdraw from BZD were more likely to stop using with the intervention (OR 1.8, IC 95 % 1.17–2.8, p = 0.007). Those with high income were more likely to quit using BZD with the intervention as those with a lower income (OR 1.81, IC 95 % 1.13–2.9, p = 0.012). Similarly, those who had previously tried to withdraw from BZD were more likely to stop using with the intervention (OR 1.8, IC 95 % 1.17–2.8, p = 0.007).

Conclusions

The intervention was effective at 6 months and its effects persist up to 5 years. The factors favouring interruption BZD seem to be having a high income and a previously tried to withdraw from BZD.

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来源期刊

Research in Social & Administrative Pharmacy PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

7.20

自引率

10.30%

发文量

225

审稿时长

47 days

期刊介绍： Research in Social and Administrative Pharmacy (RSAP) is a quarterly publication featuring original scientific reports and comprehensive review articles in the social and administrative pharmaceutical sciences. Topics of interest include outcomes evaluation of products, programs, or services; pharmacoepidemiology; medication adherence; direct-to-consumer advertising of prescription medications; disease state management; health systems reform; drug marketing; medication distribution systems such as e-prescribing; web-based pharmaceutical/medical services; drug commerce and re-importation; and health professions workforce issues.