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Brief interventions targeting long-term benzodiazepine and Z-drug use in primary care: a systematic review and meta-analysis
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Date
2020-01-27
Authors
Lynch, Tom
Ryan, Cristín
Hughes, Carmel M.
Presseau, Justin
van Allen, Zachary M.
Bradley, Colin P.
Cadogan, Cathal A.
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John Wiley & Sons, Inc.
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Abstract
Aims: To assess the effectiveness of brief interventions in primary care aimed at reducing or discontinuing long‐term benzodiazepine/Z‐drug (BZRA) use. Method: Systematic review of randomised controlled trials of brief interventions in primary care settings aimed at reducing or discontinuing long‐term BZRA use in adults taking BZRAs for ≥3 months. Four electronic databases were searched: PubMed, EMBASE, PsycINFO, CENTRAL. The primary outcome was BZRA use, classified as discontinuation or reduction by ≥25%. The Theoretical Domains Framework (TDF) was used to retrospectively code behavioural determinants targeted by the interventions. The Behaviour Change Technique (BCT) Taxonomy was used to identify interventions’ active components. Study‐specific estimates were pooled, where appropriate, to yield summary risk ratios (RRs) and 95% confidence intervals (CIs). Pearson correlations were used to determine the relationship between intervention effect size and the results of both the TDF and BCT coding. Results: Eight studies were included (n=2071 patients). Compared with usual care, intervention patients were more likely to have discontinued BZRA use at 6 months (8 studies, RR 2.73, 95% CI 1.84‐4.06) and 12 months post‐intervention (2 studies, RR 3.41, 95% CI 2.22‐5.25). TDF domains ‘Knowledge’, ‘Memory, attention and decision processes’, ‘Environmental context and resources’ and ‘Social influences’ were identified as having been included in every intervention. Commonly identified BCTs included ‘Information about health consequences’, ‘Credible source’ and ‘Adding objects to the environment’. There was no detectable relationship between effect size and the results of either the TDF or BCT coding. Conclusion: Brief interventions delivered in primary care are more effective than usual care in reducing and discontinuing long‐term benzodiazepine/Z‐drug use.
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Keywords
Brief intervention , Primary care , Long-term benzodiazepine use , BZRA
Citation
Lynch, T., Ryan, C., Hughes, C. M., Presseau, J., van Allen, Z. M., Bradley, C. P. and Cadogan, C. A. (2020) 'Brief interventions targeting long-term benzodiazepine and Z-drug use in primary care: a systematic review and meta-analysis', Addiction. doi: 10.1111/add.14981
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© 2020, John Wiley & Sons, Inc. This is the peer reviewed version of the following article: Lynch, T., Ryan, C., Hughes, C. M., Presseau, J., van Allen, Z. M., Bradley, C. P. and Cadogan, C. A. (2020) 'Brief interventions targeting long-term benzodiazepine and Z-drug use in primary care: a systematic review and meta-analysis', Addiction, doi: 10.1111/add.14981, which has been published in final form at https://doi.org/10.1111/add.14981. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.