Pharmacists and GPs work together to support benzodiazepine withdrawal
| Many patients want to stop taking
benzodiazepines. Debbie Andalo finds out how they can be helped |
Many programmes have been developed to help patients
stop taking benzodiazepines and, in one of the latest, a practice pharmacist
and a GP have successfully
been working together.
In a pilot — which is due to be extended across a primary care
trust area — around 50 per cent of those patients who had been
on the drugs long-term, and wanted to stop taking them, have done so.
GPs at the practice in Cleveland have in the past offered benzodiazepines
on a 14-day acute prescription but they were keen to reach those patients
who had been on repeat prescriptions for a long time. Since the pilot
was launched two years ago, six of the 16 practices in Langbaurgh Primary
Care Trust have also developed a partnership with their support pharmacist
to tackle benzodiazepine use.
Now the PCT is planning to employ a specialist mental health nurse to
work across all practices to give extra support to the pharmacists and
GPs to tackle the problem of those patients who have been on benzodiazepines
long term.
The initiative coincides with plans by chief medical officer in England
Sir Liam Donaldson to introduce “installment dispensing” for
benzodiazepines where pharmacists, relying on a GP’s single prescription,
can dispense the drug daily in an attempt to reduce patient access and
control GP prescribing to ensure they reflect national prescribing guidelines
(PJ, 28 February, p238).
The prescribing project in Cleveland began after GPs at the Woodside
Surgery wanted their pharmacist, Elizabeth Walker, to help them address
the number of patients who had been taking diazepam, nitrazepam and temazepam
for a long time. Mrs Walker carried out an audit of patient records and
sifted out those patients who were on long-term use, in some cases up
to 20 years, who had no record of intervention with psychiatric services.
She said: “These were just ordinary people, with no mental health
issues who were on these drugs.”
The patients were then written to and invited to attend a practice clinic
where they would be supported in being weaned off the drugs in a structured
way. They were also sent a “sleep hygiene” leaflet, which
spelt out simple advice for having a good night’s sleep. Patients
were reminded to relax towards the end of the evening and not to drink
coffee late at night.
Perhaps surprisingly the pack was the only catalyst which some patients
needed to wean themselves off the drugs. Mrs Walker said: “Some
of the patients would come in and say to me ‘I have gone down from
two to one and a half tablets’. At the clinic we would spend time
talking to them but it was the patient who made the final decision. The
significance, I think, was that we were supporting those patients who
were interested in being helped.
“ The practice was also supportive because it was something which
the GPs wanted me to look at.”
Behavioural therapy training
She suggested that other pharmacists who are keen to introduce a similar
scheme might consider having some cognitive behavioural therapy training.
“I hope that I am able to empathise with people but I think some
formal cognitive behavioural therapy would be useful. I probably could
have
benefited from some specialist training beforehand.”
Stephen Childs, the PCT’s director of primary and community services,
said local GPs were committed to reducing benzodiazepine prescribing
and meeting government guidelines but were pressed for time.
He admitted: “GPs don’t always feel they have got the time
they need to devote to these patients — the time that is needed
to counsel them off the drugs and what we want to do is bring in dedicated
support.
“
I think we may end up with a combination of support provided by the practice
pharmacists — who work a maximum two sessions a week in a practice — and
the specialist nurse.”
He said the pharmacists are good at supporting patients who are being
weaned off benzodiazepines but lack the specialist knowledge that a mental
health nurse would have in managing the cause of the original problem
which led to the drugs being prescribed.
Mr Childs said the benzodiazepines initiative has worked well because
of the improved inter-professional relationship between GPs and pharmacists
in the past two years. “Before we used to have to push the pharmacists
on practices, but now the GPs can’t get enough of their support — it’s
a complete turn around. I think another benefit from this is that it
opens up the door for a lot more work between GPs and community pharmacists
who are increasingly working with practices. I think our pharmacist team
has opened up GPs’ minds about what they can offer.”
GP Carolyn Rigby, whose Woodside Surgery was involved in the original
project, said the practice did not have a particularly high prescribing
rate for benzodiazepines. She explained that the GPs had traditionally
offered benzodiazepines on 14-day prescription but some patients who
had been using the long term received their drugs on repeat prescription.
She said: “GPs are busy and we don’t always have the time
to do the things as perfectly as we would like to and to have somebody
like a pharmacist come in to do this work for us is extremely useful.”
She said the practice was now trying to persuade all its patients who
have been on long-term benzodiazepines to have only a two-week prescription. |
