Rebook for review, ongoing support and encouragement as appropriate
o Continue dose reduction at pace comfortable to patient
o Monitor withdrawal effects until stopped completely or at lowest dose to control effects of withdrawal. Where complete withdrawal may not be an achievable goal there is still benefit to be gained in reducing use to the minimum effective dose. (Ref BNF).
o Revisit benefits of stopping at every contact
o Highlight risks for drivers, including details of the proposed 2015 drug driving offence for those affected.
o Link patient into support services (Talking Therapies, SMART/T2, age concern, Community Veterans Mental Health Service)
What were the potential barriers to success?
* Not perceived to be a problem
* Cheap drugs – budget not affected
* Time & impact required
* More commonly used Z drugs are perceived to be safer than temazepam
* Patient resistance
* Limited support programmes available within mental health services
Number of patients seen/telephoned by GPs was not measured. Number of pharmacist led clinic sessions 14 (First clinic January 2014: Last clinic January 2015)
> Number of patients seen 45
> Number of patient appointments attended 97
> Number of DNA 2
X Surgery Q2 (Oct-Dec 13) 2013/14 ADQ 461
X Surgery Q2 (Oct-Dec 14) 2014/15 ADQ 263
After the conclusion of the project, X surgery (Q2 2014/15) moved from 4th highest hypnotic ADQ per STAR PU prescribers to 29th out of 50 practices and below England average.
The inclusion of this prescribing performance indicator meant that all 50 practices received a consistent message regarding harms of long term use together with the offer of additional support material. A decrease can be seen by a large number of practices.
No other practice achieved the same magnitude of reduction as X surgery (as seen in Graph 1 below), who had received a higher level of support in terms of education, letters sent to patients and pharmacist led clinics over this time period. (Latest epact data available Q2 14/15)
Graph 1 – highlighting X Surgery
Medication Results: [12 month time period Oct12 – Nov13 vs Oct13 – Nov 14 (ePACT)]
The number of items dispensed decreased by 572, despite changing prescriptions to 30 days supply and thereby potentially increasing the number of items ordered.
The annual cost of hypnotic and benzodiazepine prescriptions reduced by £8,744.35, despite temazepam price fluctuations.