Blended care to discontinue benzodiazepine receptor agonists use in patients with chronic insomnia disorder: a pragmatic cluster randomized controlled trial in primary care

Kristien Coteur, Gilles Henrard, Birgitte Schoenmakers, Annouschka Laenen, Kris Van den Broeck, An De Sutter, Sibyl Anthierens, Dirk Devroey, Nadine Kacenelenbogen, Anne-Marie Offermans, Marc Van Nuland

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4 Citations (Scopus)
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Abstract

Study Objectives: International guidelines recommend using benzodiazepine receptor agonists (BZRA) for maximally four weeks. Nevertheless, long-term use for chronic insomnia disorder remains a common practice. This study aimed to test the effectiveness of blended care for discontinuing long-term BZRA use in general practice. Methods: A pragmatic cluster randomized controlled superiority trial compared blended care to usual care through urine toxicology screening. In the intervention, care by the general practitioner (GP) was complemented by an interactive e-learning program, based on cognitive behavioral therapy for insomnia. Adults using BZRA daily for minimally 6 months were eligible. Participants were clustered at the level of the GP surgery for allocation (1:1). Effectiveness was measured as the proportion of patients who had discontinued at one-year follow-up. Data analysis followed intention-to-treat principles. Results: In total, 916 patients in 86 clusters, represented by 99 GPs, were randomized. Primary outcome data was obtained from 727 patients (79%). At one-year follow-up, 82 patients (18%) in blended care, compared to 91 patients (20%) in usual care, had discontinued. There was no statistically significant effect for the intervention (OR: 0.924; 95% CI: 0.60; 1.43). No adverse events were reported to the research team. Conclusions: The findings did not support the superiority of blended care over usual care. Both strategies showed clinical effectiveness, with an average of 19% of patients having discontinued at one-year follow-up. Further research is important to study the effect of structurally implementing digital interventions in general practice.

Original languageEnglish
Article number zsac278
Number of pages10
JournalSleep
Volume46
Issue number4
Early online date22 Nov 2022
DOIs
Publication statusPublished - 12 Apr 2023

Bibliographical note

Publisher Copyright:
© Sleep Research Society 2022. Published by Oxford University Press on behalf of the Sleep Research Society.

Copyright:
This record is sourced from MEDLINE/PubMed, a database of the U.S. National Library of Medicine

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