Dollman W B, Leblanc V T, Stevens L, O'connor P J, Roughead E E, Gilbert A L
Department of Health, Rundle Mall, SA, Australia.
J Clin Pharm Ther. 2005 Oct;30(5):425-32. doi: 10.1111/j.1365-2710.2005.00674.x.
This study aimed to evaluate the impact, in a regional setting, of a multi-strategic partnership approach for reducing benzodiazepine use in the management of insomnia, as recommended in Australia's National Policy on Quality Use of Medicines.
The setting was a rural region of South Australia, covering approximately 2000 km2, with a population of over 20 000. The study involved participatory action research, with qualitative and quantitative evaluations. The intervention involved a multi-strategic approach, including provision of treatment guidelines, provision of consumer information, a local media campaign and education and training of health professionals. The quantitative evaluation involved a single region before/after study with 2 years of follow-up using pharmacy-based dispensing data for benzodiazepines and antidepressants, gathered for the months of November to April in 1998/99 ('before' period) through to 2000/01 ('after' period). The data were analysed using non-parametric statistics.
There was a 19% reduction in benzodiazepine dispensing 2 years after the intervention compared with a 6% reduction nationally. Dispensing of antidepressants increased by 33%, compared with a 28% increase nationally.
It was concluded that the multi-strategic approach to the management of sleep disorders proved successful in promoting the use of non-drug alternatives, achieving sustained reduction in benzodiazepine consumption in a rural community, without therapeutic substitution of antidepressants.
The study demonstrated that a sustainable reduction in prescribing of benzodiazepines can be achieved through the implementation of a multi-strategic approach involving local consumers, health professionals, a Division of General Practice, a government department, aged-care facilities and the local media.
本研究旨在评估澳大利亚《药品合理使用国家政策》中推荐的多策略伙伴关系方法在区域范围内对减少失眠管理中苯二氮䓬类药物使用的影响。
研究地点为南澳大利亚的一个农村地区，面积约2000平方公里，人口超过2万。该研究采用参与式行动研究，并进行定性和定量评估。干预措施包括多策略方法，如提供治疗指南、提供消费者信息、开展当地媒体宣传活动以及对卫生专业人员进行教育和培训。定量评估采用单区域前后对照研究，随访2年，使用1998/99年11月至4月（“干预前”阶段）至2000/01年（“干预后”阶段）期间苯二氮䓬类药物和抗抑郁药的药房配药数据。数据采用非参数统计分析。
干预后2年，苯二氮䓬类药物的配药量减少了19%，而全国范围内减少了6%。抗抑郁药的配药量增加了33%，而全国范围内增加了28%。
得出的结论是，睡眠障碍管理的多策略方法在促进非药物替代方案的使用方面被证明是成功的，在农村社区实现了苯二氮䓬类药物消费量的持续减少，且没有抗抑郁药的治疗替代。
该研究表明，通过实施一种涉及当地消费者、卫生专业人员、全科医疗部门、政府部门、老年护理机构和当地媒体的多策略方法，可以实现苯二氮䓬类药物处方量的可持续减少。
