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Huon JF, Nizet P, Caillet P, Lecompte H, Victorri-Vigneau C, Fournier JP. Evaluation of the effectiveness of a joint general practitioner-pharmacist intervention on the implementation of benzodiazepine deprescribing in older adults (BESTOPH-MG trial): protocol for a cluster-randomized controlled trial. Front Med (Lausanne) 2023; 10:1228883. [PMID: 37711743 PMCID: PMC10498124 DOI: 10.3389/fmed.2023.1228883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/15/2023] [Indexed: 09/16/2023] Open
Abstract
Background Deprescribing benzodiazepines and related drugs (BZDR) is a challenge due to a lack of time on physicians' part, a lack of involvement of other health professionals, and the need for adapted tools. This study is based on primary care collaboration, by evaluating the effectiveness of a joint intervention between general practitioners and community pharmacists on the implementation of BZDR deprescribing in older adults. Methods This is a cluster randomized controlled trial in which each cluster will be formed by a physician-pharmacist pair. Within a cluster allocated to the intervention, the pharmacist will be trained in motivational interviewing (MI), and will offer the patient 3 interviews after inclusion by the physician. They will base their intervention on validated deprescribing guidelines. The pharmacist will receive methodological support during the first interviews. Interprofessional collaboration will be encouraged by writing reports for the physician after each interview. The following implementation outcomes will be evaluated: acceptability/adoption, appropriateness, cost, and fidelity. They will be measured by means of sociological interviews, observations, logbooks, and cost-utility analysis. Focus groups with physicians and pharmacists will be carried out to identify levers and barriers experienced in this collaboration. Observations will be conducted with pharmacists to assess their approach of the MIs. Effectiveness outcomes will be based on medication (discontinuation or reduction of BZDR) and clinical outcomes (such as quality of life, insomnia or anxiety), assessed by health insurance databases and validated questionnaires. Discussion This study will determine whether collaboration in primary care between physicians and pharmacists, as well as training and coaching of pharmacists in motivational interviewing, allows the implementation of BZDR deprescribing in the older adults.This study will provide an understanding of the processes used to implement deprescribing guidelines, and the contribution of collaborative practice in implementing BZDR discontinuation. The cluster methodology will allow to assess the experience of the relationship between the different primary care actors, and the related obstacles and levers.The results obtained will make it possible to produce guidelines on the involvement of community pharmacists in the management of substance abuse in older adults, or even to legislate new missions or care pathways. Clinical trial registration ClinicalTrials.gov, identifier, NCT05765656.
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Affiliation(s)
- Jean-François Huon
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, Nantes, France
- Nantes Université, CHU Nantes, Pharmacie, Nantes, France
| | - Pierre Nizet
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, Nantes, France
- Nantes Université, CHU Nantes, Pharmacie, Nantes, France
| | - Pascal Caillet
- Public Health Department, Nantes Université, CHU Nantes, Nantes, France
| | - Hélène Lecompte
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, Nantes, France
| | - Caroline Victorri-Vigneau
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, Nantes, France
- Centre d'évaluation et d'information sur la Pharmacodépendance-Addictovigilance, CHU Nantes, Nantes, France
| | - Jean-Pascal Fournier
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, Nantes, France
- Département de Médecine Générale, Université de Nantes, Nantes, France
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Carton L, Niot C, Kyheng M, Petrault M, Laloux C, Potey C, Lenski M, Bordet R, Deguil J. Lack of direct involvement of a diazepam long-term treatment in the occurrence of irreversible cognitive impairment: a pre-clinical approach. Transl Psychiatry 2021; 11:612. [PMID: 34857741 PMCID: PMC8640018 DOI: 10.1038/s41398-021-01718-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 09/20/2021] [Accepted: 10/25/2021] [Indexed: 11/11/2022] Open
Abstract
Several observational studies have found a link between the long-term use of benzodiazepines and dementia, which remains controversial. Our study was designed to assess (i) whether the long-term use of benzodiazepines, at two different doses, has an irreversible effect on cognition, (ii) and whether there is an age-dependent effect. One hundred and five C57Bl/6 male mice were randomly assigned to the 15 mg/kg/day, the 30 mg/kg/day diazepam-supplemented pellets, or the control group. Each group comprised mice aged 6 or 12 months at the beginning of the experiments and treated for 16 weeks. Two sessions of behavioral assessment were conducted: after 8 weeks of treatment and after treatment completion following a 1-week wash-out period. The mid-treatment test battery included the elevated plus maze test, the Y maze spontaneous alternation test, and the open field test. The post-treatment battery was upgraded with three additional tests: the novel object recognition task, the Barnes maze test, and the touchscreen-based paired-associated learning task. At mid-treatment, working memory was impaired in the 15 mg/kg diazepam group compared to the control group (p = 0.005). No age effect was evidenced. The post-treatment assessment of cognitive functions (working memory, visual recognition memory, spatial reference learning and memory, and visuospatial memory) did not significantly differ between groups. Despite a cognitive impact during treatment, the lack of cognitive impairment after long-term treatment discontinuation suggests that benzodiazepines alone do not cause irreversible deleterious effects on cognitive functions and supports the interest of discontinuation in chronically treated patients.
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Affiliation(s)
- Louise Carton
- Univ. Lille, Inserm, CHU Lille, Lille Neuroscience and Cognition, Degenerative and Vascular Cognitive Disorders, UMR-S1172, 59000, Lille, France.
| | - Candice Niot
- Pharmacy Service, Arras Hospital Center, 62000 Arras, France
| | - Maéva Kyheng
- grid.410463.40000 0004 0471 8845Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, 59000 Lille, France ,grid.410463.40000 0004 0471 8845Département de Biostatistiques, CHU Lille, 59000 Lille, France
| | - Maud Petrault
- grid.410463.40000 0004 0471 8845Univ. Lille, Inserm, CHU Lille, Lille Neuroscience and Cognition, Degenerative and Vascular Cognitive Disorders, UMR-S1172, 59000 Lille, France
| | - Charlotte Laloux
- grid.410463.40000 0004 0471 8845Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, US 41 - UMS 2014 - PLBS, Lille In vivo Imaging and Functional Exploration, 59000 Lille, France
| | - Camille Potey
- grid.410463.40000 0004 0471 8845Univ. Lille, Inserm, CHU Lille, Lille Neuroscience and Cognition, Degenerative and Vascular Cognitive Disorders, UMR-S1172, 59000 Lille, France
| | - Marie Lenski
- grid.410463.40000 0004 0471 8845Univ. Lille, CHU Lille, Institut Pasteur de Lille, ULR 4483 - IMPECS – Impact de l’Environnement Chimique sur la Santé, 59000 Lille, France
| | - Régis Bordet
- grid.410463.40000 0004 0471 8845Univ. Lille, Inserm, CHU Lille, Lille Neuroscience and Cognition, Degenerative and Vascular Cognitive Disorders, UMR-S1172, 59000 Lille, France
| | - Julie Deguil
- grid.410463.40000 0004 0471 8845Univ. Lille, Inserm, CHU Lille, Lille Neuroscience and Cognition, Degenerative and Vascular Cognitive Disorders, UMR-S1172, 59000 Lille, France
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Garbarino S, Lanteri P, Bragazzi NL, Gualerzi G, Riccò M. Occupational Injuries and Use of Benzodiazepines: A Systematic Review and Metanalysis. Front Hum Neurosci 2021; 15:629719. [PMID: 34054447 PMCID: PMC8155305 DOI: 10.3389/fnhum.2021.629719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 04/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Benzodiazepines have been widely used in clinical practice for over four decades and continue to be one of the most consumed and highly prescribed class of drugs available in the treatment of anxiety, depression, and insomnia. The literature indicates that Benzodiazepine users at a significantly increased risk of Motor Vehicle accidents compared to non-users but the impact on injuries at workplace is not well-defined. We aimed to investigate whether use of benzodiazepine is associated with increased risk of occupational injuries (OI). Methods: PubMed, Embase, and Scopus databases were searched. A meta-analysis was performed to calculate odds ratio (OR) and 95% confidence interval (CI) among case controls, cross-sectional studies, either questionnaire or laboratory exams based. Results: A total of 13 studies met inclusion criteria, involving 324,168 OI from seven different countries, with an estimated occurrence of benzodiazepine positivity of 2.71% (95% CI 1.45–4.98). A total of 14 estimates were retrieved. Of them, 10 were based on laboratory analyses, three on institutional databases, while one study was based on questionnaires. Regarding the occupational groups, three estimates focused on commercial drivers (0.73%, 95% CI 0.12–4.30), that exhibited a reduced risk ratio for benzodiazepine positivity compared to other occupational groups (RR 0.109, 95% CI 0.063–0.187). Eventually, no increased risk for benzodiazepine positivity was identified, either from case control studies (OR 1.520, 95% CI 0.801–2.885, I2 76%), or cross sectional studies, when only laboratory based estimates were taken in account (OR 0.590, 95% CI 0.253–1.377, I2 63%). Conclusions: Even though benzodiazepines have the potential to increase injury rates among casual and chronic users, available evidence are insufficient to sustain this hypothesis, particularly when focusing on laboratory-based studies (i.e., studies the characterized the benzodiazepine immediately before the event).
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Affiliation(s)
- Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal/Child Sciences (DINOGMI), University of Genoa, Genoa, Italy
| | - Paola Lanteri
- UOC Neurophysiopathology, Fondazione IRCCS, Istituto Neurologico "C. Besta," Milan, Italy
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Giovanni Gualerzi
- Department of Medicine and Surgery, School of Medicine, University of Parma, Parma, Italy
| | - Matteo Riccò
- AUSL-IRCCS di Reggio Emilia-Department of Public Health, Service for Health and Safety in the Workplace, Reggio Emilia, Italy
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Chan HY, Cheng SW, Sun HJ. Prescription patterns and trends of anxiolytics and hypnotics/sedatives among child and adolescent patients with psychiatric illnesses in a psychiatric center of northern Taiwan. TAIWANESE JOURNAL OF PSYCHIATRY 2021. [DOI: 10.4103/tpsy.tpsy_18_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Aouizerate B, El-Hage W. [Only good therapeutic strategies! Response to the letter about the special issue: "All the truth about benzodiapzépines"]. Presse Med 2019; 48:217-218. [PMID: 30853283 DOI: 10.1016/j.lpm.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Bruno Aouizerate
- Pôle de psychiatrie générale et universitaire, centre hospitalier Charles Perrens, centre expert dépression résistante FondaMental, 33000 Bordeaux, France; Université de Bordeaux, NutriNeuro, UMR Inra 1286, 33000 Bordeaux, France
| | - Wissam El-Hage
- CHRU de Tours, centre expert dépression résistante FondaMental, 37000 Tours, France; Université de Tours, U1253, iBrain, Inserm, 37000 Tours, France.
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