33 An Intervention to Decrease Benzodiazepine Prescribing by Providers in an Urban Clinic

Abstract

STUDY OBJECTIVES

Outpatient benzodiazepine use can cause side effects including dependence (20–30%) and death from respiratory depression when used with alcohol or opioids. Benzodiazepine use is on the rise in the U.S., increasing 67% from 1996–2013. In this quality improvement project, two educational interventions were combined with the intent of decreasing benzodiazepine prescribing by providers (MDs, APRNs) in an urban university clinic.

STUDY QUESTION

When prescribers working in a low-income clinic receive an intervention to increase awareness of benzodiazepine dangers and promote harm reduction strategies compared to treatment as usual, do they write fewer benzodiazepine prescriptions in the month following the intervention?

METHOD

A hybrid intervention combining academic detailing (educational outreach visits) and pharmaceutical industry detailing (merchandising, relationship building) was provided in two sessions to family practice providers (salaried and residents) working in a university outpatient clinic in Chicago. The subject matter included benzodiazepine risks, alternative treatments for anxiety & insomnia, and methods to deal with patient demand. All clinic providers (n=40) were invited to participate. Participants were self-selected to attend each session (although resident physicians were obligated to attend). A total of 20–24 providers attended each session.

Benzodiazepine prescription information was extracted by clinic information systems for two periods: 12months pre-intervention, and 30days post-intervention. For ease of comparison, each prescription was converted to a common denominator: the diazepam-equivalent dose. The pre-intervention monthly average (for one year) was compared to 30-day post-intervention data. The outcome measure was the numeric difference in the prescribed diazepam-equivalents pre- and post-intervention. This number was used as a measure of the effectiveness of the intervention. A decrease in prescribing post- compared to pre-intervention would indicate a successful intervention.

RESULTS

There was an 80% decrease in benzodiazepine prescribing in the 30-day post-intervention period compared to the 12-month pre-intervention monthly average. This result cannot be explained by personnel changes at the clinic. Although these did occur in 2017, the pattern of prescribing was stable throughout the year prior to this intervention.

CONCLUSIONS

The combination of academic and pharmaceutical industry detailing influenced family practice providers in an urban clinic setting to decrease benzodiazepine prescribing by 80%. Decreased benzodiazepine prescribing should decrease patient morbidity and mortality.