Benzodiazepine management in primary care: barriers and facilitators

Problematic benzodiazepine use is a global health issue. The complications of long-term use jeopardise the personal health of benzodiazepine users and come along with substantial socio-economic costs. Although the adverse side effects of long-term use of benzodiazepines are well known, it remains difficult to implement interventions for discontinuation in primary care.

Multiple reviews have concluded that psychosocial interventions, being minimal interventions, Cognitive Behavioural Therapy for insomnia (CBTi), and tapering, prove effective. Recent reviews have also suggested that multi-faceted interventions and a step-wise approach are most likely to be successful. However, there is a lack of knowledge with regard to the benefits and sustainability of these interventions. Moreover, a scoping review, published in 2015, revealed there is a gap in the literature when it comes to knowing which mechanisms provide success. Why does an intervention work? For who? Which contextual factors influence the success of an intervention?

Therefore, this research project focuses on both limiting and facilitating factors for the discontinuation of chronic benzodiazepine use in an adult population with primary insomnia. To identify relevant factors a mixed method research design is used. This includes a realist review on the mechanisms of psychosocial interventions for an adult population of chronic benzodiazepine users with primary insomnia, a pragmatic clustered randomized controlled trial (RCT) that evaluates the effectiveness of a blended care approach in primary care, participatory design research to develop patient educational materials, and in-depth interviews to explore patients’ and general practitioners’ experiences.

The goal of the project is to expand the evidence base for psychosocial interventions with regard to benzodiazepine management in primary care. By exploring how these interventions affect a population with primary insomnia, by mapping patient and general practitioner factors that influence motivation and persistence to discontinue chronic use of benzodiazepines, and by evaluating a blended care approach, this project will lead to more informed decision-making and support in the withdrawal process. Meaning that it will contribute in narrowing the gap between knowledge and implementation. Finally, the project will facilitate providing multi-faceted interventions in primary care through the development of practical materials.

In this short presentation, we will briefly discuss the project in its entirety and zoom in on the set-up and conduct of the pragmatic clustered RCT on the effectiveness of a blended care approach.