Benzodiazepine deprescribing in an urban deprived general practice

Naomi Smith

Keywords: deprescribing benzodiazepines general practice

Setting:

This project took place in an urban deprived general practice in Ballyfermot, Dublin, an area of great deprivation. The practice has around 1700 adult patients. The project began in August 2022, with the most recent data collection in January 2024. This area has historically high rates of benzodiazepine prescriptions. Benzodiazepine abuse is common in this area.

Target group:

Patients on long term prescriptions for diazepam, the most common benzodiazepine involved. Many were on diazepam for decades. Age range 29 – 98. The median age was 69.5. 75% of patients female, 25% male.

Description of the innovative practice or project:

A retrospective audit was carried out in June 2022 auditing diazepam prescribed, patient age, gender and monthly prescribed diazepam dose. Exclusion criteria: Age <18, patients receiving hospital prescriptions for diazepam.
We then conducted education sessions with practice staff about the aim to reduce benzodiazepine prescribing in the practice. This is a long term project aimed at encouraging buy in from patients in a supportive environment. Alerts were placed on patient charts to flag that a benzodiazepine discussion was due. During routine consultations, we gave informative material and informed re alternatives. Patients were weaned gradually. We re-audited at 8 months and 16 months.

Evaluation:

Review at 8 months showed a 24% decrease in the total quantity of diazepam prescribed. 51% of patients had a reduction in their dosage. 4% patients completely ceased their use of benzodiazepines.
Data collection in January 2024, 67.4% of patients engaged and either reduced/ceased their diazepam. 17.4% have been fully weaned off of benzodiazepines. Overall there was a 43.7% in the total monthly diazepam prescribed.

Next Steps:

This project continues. We will share our results with our community to show this is a feasible project with encouraging results.

Lessons learned:

A slow and empathetic response to patients with regular encouragement was important to the project's success. Time has been a valuable factor.

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