Pharmacist-Led Taper with Brief Mindfulness-Informed Cognitive Behavioral Therapy for Benzodiazepine Deprescribing in Older Adults: A Pilot Trial.

Background: Chronic benzodiazepine use remains common among older adults, despite limited evidence of benefit and substantial risks. Evidence-based approaches that are feasible in primary care settings are needed to support benzodiazepine deprescribing for older adults.

Objectives: To determine the feasibility, acceptability, and exploratory patient-centered outcomes of a team-based approach to benzodiazepine deprescribing in primary care.

Design: Single-arm prospective clinical trial.

Participants: Adults age 65 and older prescribed long-term benzodiazepines recruited from four primary care clinics in an academic health system.

Interventions: Ten-week virtual primary care embedded program consisting of pharmacist-guided tapering and three psychologist-led mindfulness-informed cognitive behavioral therapy (CBT) sessions. Main measures: Feasibility outcomes included enrollment, retention, and intervention adherence. Acceptability outcomes were collected through qualitative interviews. Exploratory efficacy outcomes included change in mean daily benzodiazepine dose, change in PROMIS anxiety score, and change in PROMIS sleep disturbance score. Key

Results: Seventeen participants (mean age 72, 29% female, mean 17 years of benzodiazepine use) enrolled and completed all six study visits (100% fidelity). Participants' mean (SD) baseline daily benzodiazepine dose was 9.0 (8.6) diazepam milligram equivalents. At completion, participants had a mean 60.5 percentage point reduction in benzodiazepine use (95% CI -69.9% to -51.3%; p < .001), with all participants reducing their dose and 3 stopping completely. Mean PROMIS anxiety scores decreased from 55.2 to 51.8 (-3.5 point change, 95% CI -6.5 to -0.7; p = 0.02) and mean PROMIS sleep disturbance scores were unchanged at week 10 (-1.7 point change, 95% CI -4.9 to 1.5; p = 0.30). Qualitative interviews indicated the program may target increased self-efficacy to reduce benzodiazepines and endorsed utility from both pharmacist- and psychologist-led components.

Conclusions: A primary care embedded virtual intervention involving pharmacist-led tapering and mindfulness-informed CBT sessions to support benzodiazepine deprescribing is feasible, acceptable, may reduce older adults' benzodiazepine use, and warrants multi-site testing. Clinicaltrials: Gov trial number: NCT06119308. Clinicaltrials: Gov registration date: 10/27/2023.