A benzodiazepine discontinuation programme does not increase the frequency of contacts with the family practice

Figures & data

Figure 1.  Flow diagram. ^1“Other individual FP reasons” refers to those exclusions made at the specific instigation of the FP for individual reasons of comorbidity, psychosocial reasons, high age, severe disability, currently not in the practice.

Table I.  Charateristics of study subjects.

	Source population		Study population
	Control	Experimental	Control	Experimental
Number of practices	16	27	9	11
Number of long-term users	1821	2425	883	996
Age (years) (mean(SD))	65 (16)	62 (15)	65 (15)	61 (15)
Gender (% female)	73	71	72	69
Health insurance (% NHS)	80	80	83	84
Discontinuation programme	0	70%	0	69%
Baseline daily average of BZ^1 prescription in DDD (SD)^2	0.8 (0.8)	0.9 (1.0)	0.8 (0.7)	0.9 (1.1)
Complete BZ discontinuation at six months	12%	24%	12%	24%

Notes: ¹BZ = benzodiazepine; ²counted by using benzodiazepine equivalence rules by Zitman and Couvée [16].

Table II.  Average number of contacts (SD) per three-month period in the experimental group (n = 996) and the control group (n = 883).

	Baseline	Follow-up
	–3–0 months	Period 1 0–3 months	Period 2 4–6 months	Period 3 7–9 months	Period 4 10–12 months
Practice contacts
Experimental	6.2 (4.4)	6.3 (4.2)	6.1 (4.4)	5.7 (4.4)	5.7 (4.3)
Non-quitters (n = 752)	6.6 (4.7)	6.7 (4.2)	6.9 (4.4)	6.1 (4.6)	6.3 (4.5)
Quitters (n = 244)	5.2 (3.1)	5.1 (3.9)	4.4 (3.8)	4.3 (3.3)	4.0 (3.3)
Control	6.8 (5.0)	6.9 (4.9)	6.6 (5.0)	6.4 (4.9)	6.4 (4.8)
Non-quitters (n = 779)	7.0 (5.0)	7.2 (5.0)	7.0 (5.0)	6.7 (5.0)	6.7 (4.9)
Quitters (n = 104)	5.4 (4.0)	5.1 (4.0)	3.9 (3.5)	4.2 (3.5)	3.8 (3.6)
Prescription excluded contacts
Experimental	2.3 (2.9)	2.6 (2.7)	2.5 (2.7)	2.1 (2.8)	2.2 (2.7)
Non-quitters (n = 752)	2.3 (3.1)	2.6 (2.7)	2.6 (2.8)	2.2 (3.0)	2.4 (2.9)
Quitters (n = 244)	2.0 (2.2)	2.4 (2.8)	2.1 (2.2)	2.0 (2.1)	1.7 (2.2)
Control	2.7 (3.3)	2.9 (2.9)	2.6 (3.1)	2.4 (2.9)	2.5 (2.9)
Non-quitters (n = 779)	2.7 (3.2)	2.9 (2.9)	2.6 (3.1)	2.5 (2.9)	2.5 (2.9)
Quitters (n = 104)	2.8 (3.3)	2.7 (2.9)	2.1 (2.4)	2.1 (2.6)	2.0 (2.5)
Consultations
Experimental	0.9 (1.5)	1.0 (1.5)	1.1 (1.5)	1.0 (1.5)	0.9 (1.5)
Non-quitters (n = 752)	0.9 (1.5)	1.0 (1.5)	1.2 (1.5)	1.0 (1.5)	0.9 (1.6)
Quitters (n = 244)	0.9 (1.3)	1.0 (1.5)	1.0 (1.3)	0.9 (1.3)	0.7 (1.0)
Control	1.1 (1.7)	0.9 (1.4)	1.0 (1.4)	1.0 (1.5)	1.0 (1.4)
Non-quitters (n = 779)	1.1 (1.7)	0.9 (1.4)	1.1 (1.5)	1.0 (1.5)	1.0 (1.4)
Quitters (n = 104)	1.2 (1.7)	1.0 (1.4)	0.9 (1.1)	0.8 (1.0)	0.9 (1.0)

Table III.  Average number of prescriptions¹ (SD) per three-month period in the experimental group (n = 996) and the control group (n = 883).

	Baseline	Follow-up
	–3–0 months	Period 1 0–3 months	Period 2 4–6 months	Period 3 7–9 months	Period 4 10–12 months
Benzodiazepine prescriptions
Experimental	3.0 (2.2)	2.4 (2.5)	2.3 (2.5)	2.3 (2.5)	2.2 (2.4)
Non-quitters (n = 752)	3.3 (2.4)	2.9 (2.5)	3.0 (2.5)	2.9 (2.6)	2.8 (2.5)
Quitters (n = 244)	2.0 (1.4)	0.7 (1.0)	0.0 (0.0)	0.4 (0.8)	0.4 (0.9)
Control	2.8 (2.2)	2.6 (2.2)	2.6 (2.5)	2.5 (2.5)	2.4 (2.2)
Non-quitters (n = 779)	2.9 (2.3)	2.8 (2.2)	2.9 (2.4)	2.7 (2.5)	2.7 (2.2)
Quitters (n = 104)	2.0 (1.3)	1.2 (1.2)	0.0 (0.0)	0.6 (1.2)	0.5 (0.9)
Non-benzodiazepine prescriptions
Experimental	5.6 (5.5)	6.0 (5.7)	5.6 (5.7)	5.7 (6.0)	5.6 (5.6)
Non-quitters (n = 752)	5.8 (5.8)	6.2 (6.0)	6.0 (6.0)	6.0 (6.4)	6.0 (5.9)
Quitters (n = 244)	4.7 (4.5)	5.1 (4.8)	4.4 (4.4)	4.7 (4.3)	4.1 (4.0)
Control	6.1 (6.6)	6.6 (6.8)	6.2 (6.7)	6.1 (6.7)	6.1 (6.3)
Non-quitters (n = 779)	6.3 (6.7)	6.8 (7.0)	6.5 (6.9)	6.4 (6.8)	6.4 (6.5)
Quitters (n = 104)	4.5 (4.7)	4.7 (4.7)	3.8 (4.3)	4.1 (5.2)	3.8 (4.0)

Notes: ¹Average number of prescriptions refers to the average number of all prescriptions per subject in a three-month period. Contrary to the counting of contacts, where only one contact a day was counted in the sum there was no such restriction in counting prescriptions: all separate prescriptions of all agents were counted.

Zitman FG, Couvee JE. Chronic benzodiazepine use in general practice patients with depression: An evaluation of controlled treatment and taper-off: report on behalf of the Dutch Chronic Benzodiazepine Working Group. Br J Psychiatry 2001; 178: 317–24

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