RANDOMIZED CONTROLLED TRIAL OF REMINDERS TO ENHANCE THE IMPACT OF AUDIT IN GENERAL-PRACTICE ON MANAGEMENT OF PATIENTS WHO USE BENZODIAZEPINES

Objective-To determine whether reminder cards in medical records enhan ce the effectiveness of audit with feedback in improving the care of p atients taking long term benzodiazepine drugs. Design-Randomised trial , practices receiving feedback only in one group and practices receivi ng feedback plus reminder cards in the other group. Setting-18 general practices in Leicestershire. Subjects-Random samples of patients who had been taking a benzodiazepine anxiolytic or hypnotic drug for four weeks or longer. Main outcome measures-Entries in medical records indi cating compliance with five criteria of care: assessment of suitabilit y for withdrawal; being told about dependency; withdrawal being recomm ended; withdrawal or continuing medication; and a consultation with th e general practitioner in the past year. Data were collected before an d after feedback or feedback plus reminders. Results-Of a total popula tion of 125 846 registered with the 18 practices, 2409 (1.9%) had been taking a benzodiazepine for four weeks or longer. Of the 742 in the f irst samples, 543 (73.2%) were women, the mean (SD) age was 68.7 (14.9 ) years, and they had been taking a benzodiazepine for 10.1 (6.7) year s. The number of patients whose care complied with the criteria rose a fter the interventions to implement change. The increase was greater i n practices receiving feedback plus reminders for only two of the five criteria: ''told about dependency'' increasing from 52 (11.1%) to 118 (25.8%) in the feedback only group, and from 27 (10.5%) to 184 (43.0% ) in the feedback plus reminders group; odds ratio (OR) 1.46 (95% conf idence interval (95% CI) 1.32 to 5.21); and ''consulted in the past ye ar)) increasing from 434 (93.1%) to 411 (95.8%) in the feedback only g roup and 255 (96.6%) to 400 (99.8%) in the feedback plus reminders gro up, OR (95% CI) 13.5 (2.01 to 330.3). Conclusions-Reminder cards had o nly a Limited effect and cannot be recommended for routine use. There were improvements in the care of patients of both groups of practices and further studies are indicated to determine the the impact of both systematically developed criteria and reminders embedded into restruct ured medical records.