De-implementing inappropriate benzodiazepine prescribing in primary care: an overview of systematic reviews informed by behavioral frameworks.

backgroundThe long-term use of benzodiazepines (BZDs) poses significant health risks, including cognitive impairment, falls, and dependency, despite guidelines recommending against prolonged use. Effective deprescribing interventions are essential, but evidence on optimal strategies in primary healthcare remains fragmented.

objectiveThis overview synthesizes evidence from systematic reviews of interventions aimed at reducing inappropriate BZD prescribing in primary care. It identifies barriers and facilitators, assesses the use of behavioral theories, evaluates intervention effectiveness, and appraises methodological quality.

methodsA comprehensive literature search was conducted across four electronic databases (MEDLINE via PubMed, Cochrane Database of Systematic Reviews, Epistemonikos, and PsycINFO) up to September 15, 2024. Systematic reviews evaluating deprescription strategies targeting healthcare professionals in primary care settings were included. Two independent reviewers screened studies and extracted data on intervention characteristics, behavior change techniques, and outcomes. The AMSTAR-2 tool was used to assess methodological quality.

resultsFrom 2,577 records identified, 14 systematic reviews met inclusion criteria, comprising 279 primary studies with minimal overlap (Corrected Covered Area = 1.24%). The majority of interventions were randomized controlled trials from high-income countries, with only one review including a lower-middle-income country. Common deprescribing strategies were gradual dose reduction (71%), patient education (50%), cognitive-behavioral therapy (43%), and pharmacist-led interventions (36%). Only one review explicitly used a behavioral theory. Key barriers included patient dependency, fear of withdrawal, provider resistance, insufficient training, low self-efficacy, and limited healthcare resources. Facilitators were structured education, shared decision-making, pharmacist involvement, and goal-setting. Multifaceted interventions that integrated behavioral components, especially those involving pharmacists and structured patient education, consistently demonstrated greater and more sustained effectiveness.

conclusionsThis overview demonstrates that multifaceted interventions-particularly those integrating patient education, audit-and-feedback, and pharmacist involvement-are the most effective for reducing inappropriate benzodiazepine use in primary care. Evidence also suggests that even brief, theory-informed interventions can achieve moderate effectiveness. Despite this progress, most studies lack explicit theoretical frameworks, underscoring the need for theory-driven approaches to enhance intervention design, implementation, and sustainability. Future research should focus on patient-centered strategies, long-term adherence, and broader representation from diverse socioeconomic settings. Registered in PROSPERO (CRD42024548653).