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Interdisciplinary follow-up of benzodiazepines withdrawal in primary health care

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European Statement

Clinical Pharmacy Services

Author(s)

Claudia Elias, Alda Morgado, Daniel Amaral , Fátima Cimadeira, Nadine Ribeiro

Why was it done?

Anxiolytics, sedatives and hypnotics consumption in Portugal represents 6,1% of the drug market (1). Their prescription, which should be limited in time, 12 weeks maximum, is often prolonged. As a result, patients experience cognitive deterioration, falling risk increase and tolerance and dependence. As a result, withdrawal phenomena occur, making it difficult to stop BZD. (2) Addressing this problem at the beginning of BZD use is important, avoiding chronic use.

What was done?

An interdisciplinary team was created, involving psychologist, a clinical pharmacist and a general practitioner (GP), of Primary Health Care (PHC) for patients with insomnia or anxiety who accept to participate in the benzodiazepines (BZD) Withdrawal process.

How was it done?

In December 2021, PHC’s GP started eligible patients selection and their referral. The dose reduction schedule is selected by pharmacists and agreed with GP. During the process, psychologists help patients developing skills to overcome psychological barriers; pharmacists monitor the withdrawal process, supporting deprivation management. The interdisciplinary team is in permanent contact, favouring successful withdrawal.

What has been achieved?

Eleven patients were appointed; eight remain in follow-up. Initial prescriptions started for anxiety, insomnia and depression episodes and were continued over time. Intercurrences in personal lives and concomitant therapies changes conditioned delays in withdrawal process. On average, we managed to reduce BZD dose by 25% every 12 weeks, requiring nine pharmacist appointments. Despite difficulties, patients’ motivation and effective BZD reductions and/or ending are the desired health outcomes, suggesting the success of this intervention.

What next?

Currently, we are adjusting the method and the referral process, minimising some of the difficulties faced. We are also presenting the project to new healthcare units, as we intend to guarantee equity in access to the BZD withdrawal programme for all eligible patients.

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