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Open Access Research article

Analysis of benzodiazepine withdrawal program managed by primary care nurses in Spain

Cristina Lopez-Peig16, Xavier Mundet23*, Bartomeu Casabella1, Jose Luis del Val2, David Lacasta4 and Eduard Diogene35

Author affiliations

1 Primary Care Center Raval Sud. Institut Català de la Salut, 08001, Barcelona, Spain

2 Unitat de Suport de la Recerca Barcelona Ciutat - IDIAP Jordi Gol, redIAPP Institut Català de la Salut, Sardenya 375, 08025, Barcelona, Spain

3 Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain

4 Primary Care Center La Salut. Institut Català de la Salut, 08914, Badalona, Spain

5 Institut Català de Farmacologia, Barcelona, Spain

6 Woodberry Practice. Winchmore Hill. Enfield. NHS trust, London, UK

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Citation and License

BMC Research Notes 2012, 5:684  doi:10.1186/1756-0500-5-684

Published: 13 December 2012

Abstract

Background

Benzodiazepine (BZD), the long-term treatment of which is harmful for cognitive function, is widely prescribed by General Practitioners in Spain. Based on studies performed in other countries we designed a nurse-led BZD withdrawal program adapted to Spanish Primary Care working conditions.

Results

A pseudo-experimental (before-after) study took place in two Primary Care Centres in Barcelona. From a sample of 1150 patients, 79 were identified. They were over 44 years old and had been daily users of BZD for a period exceeding six months. Out of the target group 51 patients agreed to participate. BZD dosage was reduced every 2-4 weeks by 25% of the initial dose with the optional support of Hydroxyzine or Valerian. The rating measurements were: reduction of BZD prescription, demographic variables, the Short-Form Health Survey (SF-12) to measure quality of life, the Medical Outcomes Study (MOS) Sleep Scale, and the Goldberg Depression and Anxiety Scale.

By the end of the six-month intervention, 80.4% of the patients had discontinued BZD and 64% maintained abstinence at one year. An improvement in all parameters of the Goldberg scale (p <0.05) and in the mental component of SF-12 at 3.3 points (p = 0.024), as well as in most components of the MOS scale, was observed in the group that had discontinued BZD. No significant differences in these scales before and after the intervention were observed in the group that had not discontinued.

Conclusions

At one year approximately 2/3 of the patients had ceased taking BZD. They showed an overall improvement in depression and anxiety scales, and in the mental component of the quality of life scale. There was no apparent reduction in the sleep quality indicators in most of the analysed components. Nurses in a Primary Care setting can successfully implement a BZD withdrawal program.

Keywords:
Benzodiazepine; Habituation drug therapy; Primary care