Reducing Inappropriate Benzodiazepine Use Among Older Adults

University of Michigan

Status: Completed

Conditions: Long Term Use of Benzodiazepine

Treatments: Behavioral: Supplemental Collaborative Care; Behavioral: Educational Material

Study type: Interventional

Funder types: Other

Identifiers

NCT03405298

HUM00133623

20180230-00 (Other Grant/Funding Number)

Details and patient eligibility

About

The goal of this project is to reduce chronic benzodiazepine use through two approaches: direct patient education or direct patient education paired with additional support and encouragement from a behavioral health care manager.

Full description

This is a State of Michigan/Medicaid Match project proposal. These proposed projects are developed to address specific goals for Medicaid policies, procedures, and model programs for Medicaid Recipients in Michigan.

Benzodiazepine use in the United States is common and increases with age, used by 8.7% of patients aged 65-80 years. Benzodiazepines-which include well-known medications such as Xanax, Ativan, and Klonopin-are most commonly used for anxiety and insomnia, even though psychotherapy and alternative medications are now recommended preferentially over benzodiazepines. Use is a particular concern among older adults, given the links between benzodiazepine prescribing and a variety of adverse outcomes including falls, fractures and motor vehicle accidents.

Attempts to reduce benzodiazepine use have met with limited success in the real world, as patients are reluctant to consider the possibility of stopping them and providers are reluctant to even suggest the possibility. In the course of a brief return visit in primary care, providers simply do not have the time or incentive to engage in a potentially difficult, lengthy discussion with patients about reducing or stopping their benzodiazepine.

The goal of this project is to evaluate direct patient education compared to direct patient education paired with additional support and encouragement from a care manager in order to reduce chronic benzodiazepine use. Strategies to help reduce benzodiazepine use are of great interest to providers and our findings would have significance for all providers, and may even conceivably improve the care of patient both inside and outside the Medicaid program.

Enrollment: 44 patients

Sex: All

Ages: 50+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• With a prescription BZD supply covering ≥20% of days in the preceding 12 months ("chronic").

Exclusion criteria

• Patients with BZD supply <20% days in past 12 months
• Patients with ICD-10 codes for dementia (derived from encounter diagnosis codes)
• long-term care residents (ICD-10 codes Z59.3 and Y92.199)

Trial design

Primary purpose: Supportive Care

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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44 participants in 2 patient groups

Educational Material with Collaborative Care available

Active Comparator group

Description:

In addition to the material described below, these patients are seen in clinics with behavioral health collaborative care (BHCC), which includes a care manager in the primary care provider's office along with a consulting psychiatrist. If a patient receives the brochure and would like to taper their benzodiazepine, their provider can refer them to the BHCC care manager who can provide education and anxiety and insomnia self-management strategies, while the BHCC psychiatrist will make recommendations regarding the medication taper back to the primary care provider.

Treatment:

Behavioral: Supplemental Collaborative Care

Behavioral: Educational Material

Educational Material Only

Active Comparator group

Description:

Patients will receive an 8-page educational brochure that presents information about potential harms of these medications and a vignette about a patient that successfully stopped. It does NOT suggest patients to stop on their own, but rather suggests they speak with their provider.

Treatment:

Behavioral: Educational Material