REDUCING INAPPROPRIATE BENZODIAZEPINE USE AMONG OLDER ADULTS

Introduction Benzodiazepine use in the United States is common and increases with age, used by 8.7% of patients aged 65-80 years (Olfson, King, & Schoenbaum, 2015). 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 (Baldwin, Woods, Lawson, & Taylor, 2011; Smith et al., 2014; Wu, Appleman, Salazar, & Ong, 2015). Use is a particular concern among older adults, given the links between benzodiazepine prescribing and a variety of adverse outcomes including falls (Woolcott et al., 2009), fractures (Wang, Bohn, Glynn, Mogun, & Avorn, 2001) and motor vehicle accidents (Dassanayake, Michie, Carter, & Jones, 2011). 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 may be reluctant to suggest the possibility. In the course of a brief return visit in primary care, providers may 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 was 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. Methods We used electronic health records of four clinics in southeast Michigan to identify patients aged 50 and older who were prescribed benzodiazepines for ≥20% of days over the past 12 months (i.e., someone that gets ≥3 × 30-day supplies would be included). Patients that agreed to participate completed a brief baseline interview about their benzodiazepine use as well as symptoms of anxiety, depression, and insomnia. Participating patients received an 8-page educational brochure informed by motivational enhancement that presented information about the potential harms of benzodiazepine use and suggested patients consider talking with their physician about possibly reducing use. Patients were contacted again at 3 and 6 months to determine whether they discussed benzodiazepine use with their providers and whether symptoms had changed. Change in daily use of benzodiazepines was assessed using the electronic health record. Results Data collection has recently completed. Analyses presented will entail repeated measures ANOVAs examining changing in daily doses from baseline through the 3- and 6-month check-ins. T-tests will be conducted to examine group differences between those who discussed use with their providers or pharmacist and those who did not. Additional t-tests and chi-squares will also be conducted to examine sample characteristics (e.g., gender or other substance use) that may be associated with talking to one's providers or pharmacist. Resulting data will be presented after the above analysis is complete. Conclusions Participants’ benzodiazepine use, alcohol and illicit drug use, as well as possible risk or protective factors will be discussed. Results will inform development of direct patient education initiatives to reduce benzodiazepine use and benzodiazepine-related harms among older adults. This research was funded by Support for this work provided by the Ravitz Family Foundation.