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CMAJ • April 1, 2003; 168 (7)
© 2003 Canadian Medical Association or its licensors

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Educating physicians to reduce benzodiazepine use by elderly patients: a randomized controlled trial

Nicholas J.G. Pimlott, Janet E. Hux, Lynn M. Wilson, Meldon Kahan, Cindy Li and Walter W. Rosser

From the Department of Family and Community Medicine, Faculty of Medicine, University of Toronto (Pimlott, Wilson, Kahan, Rosser); the Institute for Clinical Evaluative Sciences (Hux, Li); the Department of Family Medicine (Pimlott) and the Department of Medicine (Hux), Sunnybrook and Women's College Health Sciences Centre; and the Department of Family Medicine, St. Joseph's Health Sciences Center (Wilson, Kahan), Toronto, Ont.

Background: Benzodiazepine use by elderly patients is associated with adverse outcomes including increased risk of falls and fractures, motor vehicle accidents and cognitive impairment. Recent studies suggest that individualized feedback and education to physicians may improve drug prescribing. In this study, we evaluated an intervention to address the inappropriate prescribing of benzodiazepines for elderly patients.

Methods: We identified 1624 primary care physicians who wrote at least 10 prescriptions for the target drugs in a 2-month period and randomly assigned these physicians to the intervention group or the control group. We obtained data from the Ontario Drug Benefit claims database, which covers all Ontario residents aged 65 years and over for drugs selected from a minimally restrictive formulary. Every 2 months for 6 months, confidential profiles of benzodiazepine prescription use coupled with evidence-based educational bulletins were mailed to the intervention group. The control group received feedback and educational bulletins about first-line antihypertension drug prescribing for elderly patients. Our main outcome measures were reductions in the proportion of each physician's total benzodiazepine prescriptions for long-acting agents, combinations of benzodiazepines with other psychoactive medications (including other benzodiazepines) and long-term benzodiazepine therapy.

Results: After randomization, 168 physicians agreed to be in the intervention group and 206 in the control group. Their demographic and prescribing characteristics were similar. Although the proportion of long-acting benzodiazepine prescriptions decreased by 0.7% in the intervention group between the baseline period and the end of the intervention period (from 20.3%, or a mean of 29.5 prescriptions, to 19.6%, or a mean of 27.7 prescriptions) and increased by 1.1% in the control group (from 19.8%, or a mean of 26.4 prescriptions, to 20.9%, or a mean of 27.7 prescriptions) (p = 0.036), this difference was not clinically significant. There was no significant difference over the study period in either combination prescribing of benzodiazepines or in prescriptions for long-term benzodiazepine therapy.

Interpretation: We did not find that a program of confidential feedback and educational material offered to Ontario primary care physicians had a clinically significant impact on their benzodiazepine prescribing.




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Prevention of Problematic or Rational Prescribing
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CMAJ, 1 Apr 2003 [Full text]