Setting up and delivering a
Specialist Benzodiazepine
Withdrawal Service in a
Primary Care Setting
Kristin Rothert
Head of Clinical Standards & Quality
Bridge Project
[email protected]
Dr Beverley Bray PhD
Head of Performance
Bridge Project
[email protected]
• Background
• What is achievable
• What next?
• Lessons learnt
• Demonstrating
outcomes
• The four decisions
that need to be made
before getting started
4. The
Bridge
B.W.
Service
1. Setting
up a
service
3. Things
to think
about
2. Making
it happen
• Implementing the
service within a
primary care setting –
who does what and
how does it all hang
together?
1. Consider:
.
What is the need within your own practice area?
2. Consider:
.
What are the barriers to delivering this service
from both your own and the patient's perspective?
First decision: Funding the service........
Second decision: What does success look like?
Second decision: What does success look like?
Second decision: What does success look like?
Second decision: What does success look like?
Third decision: Making it happen – who needs to be
around the table?
Fourth decision: Making it happen – what needs
agreeing prior to launch?
Implementation – getting stuck in!
1. Identify
practices / areas
with sufficient
need
2. Identify
target cohort
and set up
administrative
processes
• Liaise with GPs to
inform future
prescribing practices
3. Contact
target cohort
and invite for a
medication
review
4. Assess and
work with
cohort identified
1. Identify practices / areas with sufficient need for
the service and
2. Identifying the target cohort
3. Contact target cohort and invite for a medication
review
Letter to all target cohort
sent by GP
administration team
Non-responders followed
up by reminder letter
after a given period
Appointment booked
with specialist worker for
review
4. Assess and work with cohort identified
In depth
assessment
• Looks at social situation
• Looks at prescription history
and relevant information
• Agreement for patient to
participate
• Agree reduction regime in
principle – can be amended at
a later stage
• Review of reduction and
Regular
face to face
contact
Frequent
‘top up’
phone
contacts
progress made so far – flexible
reduction programme to take
into account changes in
circumstances
• Use of recognised
psychosocial therapies,
including CBT and MI based
interventions
• Allows flexibility of contact to suit
patient
• ‘Top up’ contacts to help with
anxiety associated with medication
reduction
Delivering the service – lessons learnt
Delivering the service – demonstrating outcomes....
Delivering the service – demonstrating outcomes....
Background
Bridge Benzodiazepine Withdrawal Service
• Operating since mid 2008
• Re-designed in January 2010
• Lone worker employed and supervised by Bridge
• Located within GP practices
• Initially funded by Voluntary Sector grant funding
• A Brave New World – reporting to NDTMS
The story so far
223 individuals
helped since
January 2010
75 individuals
helped since
April 2012
The story so far
50% helped to stop
their medication
completely
50% reduced by
between 25-80%
(average 52.5%)
The story so far
Average 24 weeks
receiving support
Between 9 – 47
weeks for a
medication free
outcome
Where to from here?
What ideas / thoughts will you
be taking back to your area /
practice?