A Pharmacist-Physician Collaboration to Optimize Benzodiazepine Use for Anxiety and Sleep Symptom Control in Primary Care.
INTRODUCTION
Benzodiazepines are prescribed inappropriately in up to 40% of outpatients. The purpose of this study is to describe a collaborative team-based care model in which clinical pharmacists work with primary care providers (PCPs) to improve the safe use of benzodiazepines for anxiety and sleep disorders and to assess the preliminary results of the impact of the clinical service on patient outcomes.


METHODS
Adult patients were eligible if they received care from the academic primary care clinic, were prescribed a benzodiazepine chronically, and were not pregnant or managed by psychiatry. Outcomes included baseline PCP confidence and knowledge of appropriate benzodiazepine use, patient symptom severity, and medication changes.


RESULTS
Twenty-five of 57 PCPs responded to the survey. PCPs reported greater confidence in diagnosing and treating generalized anxiety and panic disorders than sleep disorder and had variable knowledge of appropriate benzodiazepine prescribing. Twenty-nine patients had at least 1 visit. Over 44 total patient visits, 59% resulted in the addition or optimization of a nonbenzodiazepine medication and 46% resulted in the discontinuation or optimization of a benzodiazepine. Generalized anxiety symptom severity scores significantly improved (-2.0; 95% confidence interval (CI): -3.57 to -0.43).


CONCLUSION
Collaborative team-based models that include clinical pharmacists in primary care can assist in optimizing high-risk benzodiazepine use. Although these findings suggest improvements in safe medication use and symptoms, additional studies are needed to confirm these preliminary results.
['Furbish|Shannon M L|SML|', 'Kroehl|Miranda E|ME|', 'Loeb|Danielle F|DF|', 'Lam|Huong Mindy|HM|', 'Lewis|Carmen L|CL|', 'Nelson|Jennifer|J|', 'Chow|Zeta|Z|', 'Trinkley|Katy E|KE|']
D000368:Aged D001007:Anxiety D001569:Benzodiazepines D005260:Female D006801:Humans D000070516:Intersectoral Collaboration D008297:Male D008875:Middle Aged D010348:Patient Care Team D010595:Pharmacists D010820:Physicians D011320:Primary Health Care D011446:Prospective Studies D012893:Sleep Wake Disorders D011795:Surveys and Questionnaires
benzodiazepines primary care collaborative care