Implementing an online program to change benzodiazepine prescription in Portugal: a cluster randomized trial

Background: The excessive prescription of benzodiazepines (BZD) has long been considered a worldwide public health issue. Despite the existence of a large body of literature regarding interventions to change BZD prescription patterns, most fail to report significant or long-term effects. Objective: To study the effect of the implementation of a Digital Behaviour Change Intervention (DBCI) online platform – named ePrimaPrescribe – on the BZD prescription pattern. Secondarily, to determine the effect of the platform implementation on diagnosis registration coded in the same months as BZD prescription and the costs for the NHS with co-payment. Methods: We followed a cluster-randomised design to allocate 18 primary healthcare units, from a region in Portugal. The study included BZD prescriptions from 250 general practitioners (GP) for a period of 12 months before and after intervention implementation. Results: BZD was more frequently prescribed to elders and females. The most frequently prescribed BZD was alprazolam. Most prescribed BZD had a medium half-life. In most analyses, we did not find any significant change in the BZD prescription pattern. Regarding secondary outcomes, the depressive disorder was the first, anxiety disorder the second, and dementia the fifth most frequently registered diagnosis associated with BZD prescription. BZD’s co-payment represented an average expenditure of approximately 1,300 € per unit per month. Conclusion: We could not find any significant difference in the BZD prescription pattern after ePrimaPrescribe implementation. Further work is required to explore the factors influencing resistance to BZD prescription patterns.