European Journal of Clinical Pharmacology

, Volume 74, Issue 2, pp 227–231 | Cite as

The use of an electronic clinical rule to discontinue chronically used benzodiazepines and related Z drugs

  • C. Mestres Gonzalvo
  • V. Milosevic
  • B. P. C. van Oijen
  • H. A. J. M. de Wit
  • K. P. G. M. Hurkens
  • W. J. Mulder
  • R. Janknegt
  • J. M. G. A. Schols
  • F. R. Verhey
  • B. Winkens
  • P. H. M. van der Kuy
Pharmacoepidemiology and Prescription
  • 75 Downloads

Abstract

Purpose

The chronic use of benzodiazepines and benzodiazepine-related drugs (BZ/Z) in older people is common and not without risks. The objective of this study was to evaluate whether the implementation of a clinical rule promotes the discontinuation of chronically used BZ/Z for insomnia.

Methods

A clinical rule, generating an alert in case of chronic BZ/Z use, was created and applied to the nursing home (NH) setting. The clinical rule was a one-off intervention, and alerts did not occur over time. Reports of the generated alerts were digitally sent to NH physicians with the advice to phase out and eventually stop the BZ/Z. In cases where the advice was adopted, a follow-up period of 4 months on the use of BZ/Z was taken into account in order to determine whether the clinical rule alert led to a successful discontinuation of BZ/Z.

Results

In all, 808 NH patients were screened. In 161 (19.1%) of the patients, BZ/Z use resulted in a clinical rule alert. From these, the advice to phase out and stop the BZ/Z was adopted for 27 patients (16.8%). Reasons for not following the advice consisted of an unsuccessful attempt in the past (38 patients), patients family and/or patient resistance (37 patients), the non-continuous use of BZ/Z (32 patients) and indication still present (27 patients). Of the 12 NH physicians, seven adopted the advice.

Conclusions

The success rate of a clinical rule for discontinuation of chronically used BZ/Z for insomnia was low, as reported in the present study. Actions should be taken to help caregivers, patients and family members understand the importance of limiting BZ/Z use to achieve higher discontinuation rates.

Keywords

Benzodiazepines Nursing home patients Clinical rule Discontinuation 

Notes

Authors’ contributions

All authors have made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; they all have been involved in drafting the manuscript and revising it critically for important intellectual content; they all have given final approval of the version to be published; and they all agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Conception or design of the work

C Mestres Gonzalvo

V Milosevic

HAJM de Wit

BPC van Oijen

KPGM Hurkens

WJ Mulder

R Janknegt

JMGA Schols

FR Verhey

B Winkens

PHM van der Kuy

Data collection

C Mestres Gonzalvo

V Milosevic

Data analysis and interpretation

C Mestres Gonzalvo

V Milosevic

FR Verhey

B Winkens

PHM van der Kuy

Drafting the article

C Mestres Gonzalvo

Critical revision of the article

V Milosevic

HAJM de Wit

BPC van Oijen

JMGA Schols

FR Verhey

B Winkens

PHM van der Kuy

Final approval of the version to be published

C Mestres Gonzalvo

HAJM de Wit

BPC van Oijen

V Milosevic

KPGM Hurkens

WJ Mulder

R Janknegt

JMGA Schols

FR Verhey

B Winkens

PHM van der Kuy

Compliance with ethical standards

Competing interests

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: all authors had financial support from ABC Company for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • C. Mestres Gonzalvo
    • 1
    • 2
  • V. Milosevic
    • 1
  • B. P. C. van Oijen
    • 1
  • H. A. J. M. de Wit
    • 3
  • K. P. G. M. Hurkens
    • 4
  • W. J. Mulder
    • 5
  • R. Janknegt
    • 1
  • J. M. G. A. Schols
    • 6
  • F. R. Verhey
    • 7
  • B. Winkens
    • 8
  • P. H. M. van der Kuy
    • 1
    • 9
  1. 1.Department of Clinical Pharmacy, Pharmacology and ToxicologyZuyderland Medical CentreSittard-GeleenThe Netherlands
  2. 2.Department of Clinical PharmacyElkerliek HospitalHelmondThe Netherlands
  3. 3.Department of Clinical PharmacyCanisius-Wilhelmina ZiekenhuisNijmegenThe Netherlands
  4. 4.Department of Internal MedicineZuyderland Medical CentreSittard-GeleenThe Netherlands
  5. 5.Department of Internal MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
  6. 6.Department of Family Medicine and Department of Health Services ResearchMaastricht UniversityMaastrichtThe Netherlands
  7. 7.Department of Psychiatry and NeuropsychologyMaastricht UniversityMaastrichtThe Netherlands
  8. 8.Department of Methodology and StatisticsMaastricht UniversityMaastrichtThe Netherlands
  9. 9.Department of Hospital PharmacyErasmus Medical CenterRotterdamThe Netherlands

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