Background Chronic treatment revisions optimise drug treatment and prevent potential drug related problems. Therefore, we started a new healthcare model based on multidisciplinary team work, integrated and focused on the patient. This programme is a tool to revise the benzodiazepine/Z-drug prescriptions, which are increasing in older patients, and may cause adverse effects.
Purpose To evaluate the potentially inappropriate prescribing associated with benzodiazepines/Z-drugs in polymedicated patients and to determine the deprescription rate after multidisciplinary pharmacotherapy revision.
Material and methods The primary care pharmacist checked chronic treatment through multidisciplinary pharmacotherapy revision with clinical, functional and psychosocial variables, and established recommendations. The physician agreed with the patient preferences, and revised the recommendations through weekly drug safety appointments. The multidisciplinary primary care team (pharmacist, physician, nurse and patient) decided on the deprescription modifications to make. Data collected: demographics, total number of drugs, number of drug related problems, and number and type of benzodiazepines/Z-drugs before and after the revision. Data are expressed as median (Q1–Q3).
Results Patients revised:
125. Age 79.5 (75.8–84.0) years; women 30 (75%). Number of drugs 15 (13–17). Number of drug related problems/patient detected on revision 3 (2.0–3.25). Patients with a benzodiazepine/Z-drug prescribed >6 months 40 (32%) and out of these 9 (22.5%) taking 2 benzodiazepines/Z-drugs. Classification of benzodiazepines/Z-drugs: clonazepam 10 (20.4%); lorazepam 9 (18.4%); alprazolam, diazepam, lormetazepam 8 (16.3%) each; zolpidem 3 (6.1%), loprazolam 2 (4.1%) and 1 (2.0%) bromazepam. Total deprescription interventions: 49. In 4 (10%) patients the deprescription succeeded. Deprescribed drugs: 2 lorazepam, 1 loprazolam and 1 clonazepam. In 8 (20%) other patients benzodiazepine/Z-drug was switched to a better profile drug. Switched drugs: from alprazolam to lorazepam or zolpidem, from clonazepam to lorazepam, from diazepam to lorazepam or lormetazepam and from lormetazepam to zopiclona.
A third of our patients had a prescription of benzodiazepines/Z-drugs.
Half of the benzodiazepines/Z-drugs prescribed had a long half-life.
The benzodiazepine/Z-drug switching rate was higher than the deprescription rate.
Multidisciplinary pharmacotherapy revision permitted detection of potentially inappropriate prescribing and identification of drug related problems to optimise chronic treatment. New strategies are being implemented to increase the benzodiazepine/Z-drug deprescription, such as consciousness raising in the patient and closer monitoring.
References and/or acknowledgements PMID: 26141716.
No conflict of interest
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