Evidence map›Paper›PMID 29127459›Full record

ArticleEuropean journal of clinical pharmacology2018

The use of an electronic clinical rule to discontinue chronically used benzodiazepines and related Z drugs.

C Mestres Gonzalvo, V Milosevic, B P C van Oijen, H A J M de Wit, K P G M Hurkens, W J Mulder, R Janknegt, J M G A Schols, F R Verhey, B Winkens and 1 more

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Article in European journal of clinical pharmacology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

C Mestres GonzalvoDepartment of Clinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands. cmestresgonzalvo@elkerliek.nl.ORCID http://orcid.org/0000-0001-5955-2772
V MilosevicDepartment of Clinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.
B P C van OijenDepartment of Clinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.
H A J M de WitDepartment of Clinical Pharmacy, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands.
K P G M HurkensDepartment of Internal Medicine, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.
W J MulderDepartment of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
R JanknegtDepartment of Clinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.
J M G A ScholsDepartment of Family Medicine and Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.
F R VerheyDepartment of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands.
B WinkensDepartment of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands.
P H M van der KuyDepartment of Clinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.

Funding

ZonMw (NL) 113101001
6 · The paper itself

Abstract

purposeThe chronic use of benzodiazepines and benzodiazepine-related drugs (BZ/Z) in older people is common and not without risks. The objective of this study was to evaluate whether the implementation of a clinical rule promotes the discontinuation of chronically used BZ/Z for insomnia.

methodsA clinical rule, generating an alert in case of chronic BZ/Z use, was created and applied to the nursing home (NH) setting. The clinical rule was a one-off intervention, and alerts did not occur over time. Reports of the generated alerts were digitally sent to NH physicians with the advice to phase out and eventually stop the BZ/Z. In cases where the advice was adopted, a follow-up period of 4 months on the use of BZ/Z was taken into account in order to determine whether the clinical rule alert led to a successful discontinuation of BZ/Z.

resultsIn all, 808 NH patients were screened. In 161 (19.1%) of the patients, BZ/Z use resulted in a clinical rule alert. From these, the advice to phase out and stop the BZ/Z was adopted for 27 patients (16.8%). Reasons for not following the advice consisted of an unsuccessful attempt in the past (38 patients), patients family and/or patient resistance (37 patients), the non-continuous use of BZ/Z (32 patients) and indication still present (27 patients). Of the 12 NH physicians, seven adopted the advice.

conclusionsThe success rate of a clinical rule for discontinuation of chronically used BZ/Z for insomnia was low, as reported in the present study. Actions should be taken to help caregivers, patients and family members understand the importance of limiting BZ/Z use to achieve higher discontinuation rates.

Indexed as

Guidelines as TopicWithholding TreatmentAged, 80 and overBenzodiazepinesFemaleHumansHypnotics and SedativesMaleMedical Order Entry SystemsNursing HomesBenzodiazepinesHypnotics and SedativesBenzodiazepinesClinical ruleDiscontinuationNursing home patients

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.