Successful de-prescribing of benzodiazepines and other sedative hypnotics (BSH) medications in the community setting has been demonstrated by Dr. Cara Tannenbaum in Montreal. The EMPOWER cluster randomized trial engaged patients at their pharmacy when they were renewing these medications. In the intervention group, a simple patient empowerment pamphlet was given to patients by the pharmacist. This contained evidence-based information on harms versus benefits of BSH medications, and a stepwise tapering tool.
In the group receiving the empowerment pamphlet, 62% had initiated a conversation with either their pharmacist or primary care provider about the safety of the medication. Furthermore, 11% of patients reduced their dosage and 27% discontinued BSH use. Only 5% discontinued BSH in the control group.
This study showed that when patients are given direct information about risks and benefits, it led to shared decision-making around the overuse of medications that increase the risk of harm.
The Drowsy Without Feeling Lousy toolkit contains the key ingredients of EMPOWER approach, modified for the primary care setting.