{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:46:28Z","timestamp":1782845188896,"version":"3.54.5"},"reference-count":42,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"\n Background<\/jats:title>\n Long-term use of benzodiazepine receptor agonists (BZRAs) remains common despite European guidelines advising that these drugs be used in the lowest possible dose and for the shortest possible duration. Half of all BZRAs are prescribed in family practice. This creates a window of opportunity for discontinuation in primary care. Therefore, the effectiveness of blended care for the discontinuation of long-term BZRA use in adult primary care patients with chronic insomnia disorder was tested in a multicenter, pragmatic, and cluster randomized controlled superiority trial in Belgium. In the literature, information on implementing blended care in a primary care setting is scarce.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n The study aimed to contribute to a framework for the successful implementation of blended care in a primary care setting by increasing our understanding of this complex intervention through an evaluation of e-tool use and views and ideas of participants in a BZRA discontinuation trial.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Based on a theoretical framework, this study evaluated the processes of recruitment, delivery, and response using 4 components: a survey on recruitment (n=76), semistructured in-depth interviews with patients (n=18), web-based asynchronous focus groups with general practitioners (GPs; n=19), and usage data of the web-based tool. Quantitative data were analyzed descriptively, and qualitative data were analyzed thematically.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n For recruitment, the most common barriers were refusal by the patient and the lack of digital literacy, while facilitators were starting the conversation and the curiosity of patients. The delivery of the intervention to the patients was diverse, ranging from GPs who never informed the patient about their access to the e-tool to GPs consulting the e-tool in between consultations to have discussion points when the patient visited. Concerning response, patients\u2019 and GPs\u2019 narratives also showed much variety. For some GPs, daily practice changed because they received more positive reactions than expected and felt empowered to talk more often about BZRA discontinuation. Conversely, some GPs reported no changes in practice or among patients. In general, patients found follow-up by an expert to be the most important component in blended care, whereas GPs deemed the intrinsic motivation of patients to be the key element of success. An important barrier to implementation by the GP was time.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Overall, the participants who had used the e-tool were positive about its structure and content. Nevertheless, many patients desired a more tailored application with feedback from an expert and personal tapering schedules. Strict pragmatic implementation of blended care seems to only reach GPs with an interest in digitalization. Although not superior to usual care, blended care could be a complementary tool that allows tailoring the discontinuation process to the personal style of the GP and the needs of the patient.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n ClinicalTrials.gov NCT03937180; https:\/\/clinicaltrials.gov\/ct2\/show\/NCT03937180<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/43738","type":"journal-article","created":{"date-parts":[[2023,4,7]],"date-time":"2023-04-07T09:01:16Z","timestamp":1680858076000},"page":"e43738","source":"Crossref","is-referenced-by-count":8,"title":["Implementing Blended Care to Discontinue Benzodiazepine Receptor Agonist Use for Insomnia: Process Evaluation of a Pragmatic Cluster Randomized Controlled Trial"],"prefix":"10.2196","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3170-0195","authenticated-orcid":false,"given":"Kristien","family":"Coteur","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2976-6611","authenticated-orcid":false,"given":"Marc","family":"Van Nuland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1909-9613","authenticated-orcid":false,"given":"Birgitte","family":"Schoenmakers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4762-1907","authenticated-orcid":false,"given":"Sibyl","family":"Anthierens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5566-6868","authenticated-orcid":false,"given":"Kris","family":"Van den Broeck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2023,4,7]]},"reference":[{"key":"ref1","unstructured":"International Narcotics Control BoardPsychotropic Substances 2021. Statistics for 2020. Assessments of Annual Medical and Scientific Requirements for 202220222022-04-23https:\/\/www.incb.org\/documents\/Psychotropics\/technical-publications\/2021\/21-08898_Psychotropics_2021_ebook.pdf"},{"key":"ref2","unstructured":"Medicines management programmeGuidance on Appropriate Prescribing of Benzodiazepines and Z-Drugs (BZRA) for the Treatment of Anxiety and InsomniaHealth Service Executive20182022-02-20https:\/\/www.hse.ie\/eng\/about\/who\/cspd\/ncps\/medicines-management\/bzra-for-anxiety-insomnia\/guidance-on-appropriate-prescribing-of-bzra-feb-2021.pdf"},{"key":"ref3","unstructured":"CloetensHDeclercqTHabrakenHCallensJVan GastelARichtlijn voor goede medische praktijkvoering: aanpak van slaapklachten en insomnia bij volwassenen in de eerste lijn20182019-05-24WORELhttps:\/\/www.domusmedica.be\/sites\/default\/files\/WOREL%20RL%20Aanpak%20insomnie%20NL%2010102018.pdf"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.3238\/arztebl.2015.0001"},{"key":"ref5","unstructured":"FordCLawFGuidance for the Use and Reduction of Misuse of Benzodiazepines and Other Hypnotics and Anxiolytics in General Practice20142022-04-15http:\/\/www.antoniocasella.eu\/archipsy\/Ford_2014.pdf"},{"key":"ref6","unstructured":"Irish College of General Practitioners (ICGP)Guidelines for the Mangement of Depression and Anxiety Disorders in Primary Care20062020-02-13https:\/\/tinyurl.com\/4ej5rujn"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurpsy.2015.09.003"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.7399"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1111\/add.14981"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.949"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.113.134650"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.2196\/mental.4534"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.9873"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1080\/16506073.2017.1401115"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2021.101567"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-033688"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1186\/1745-6215-14-15"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsac278"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-017-0605-9"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39517.495764.25"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)17670-8"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-016-1513-z"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-011260"},{"key":"ref24","first-page":"2018","year":"2018","journal-title":"Published online"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2019.101214"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X08327068"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-6-42"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.cd009652"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1111\/cpsp.12348"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1016\/s2589-7500(20)30135-7"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2015.06.001"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1108\/ijchm-11-2017-0715"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.5437\/08956308x5503055"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.1014734"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.7666"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1016\/j.invent.2021.100440"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-7-37"},{"key":"ref38","author":"Silverman, J","year":"2013","journal-title":"Skills for Communicating with Patients"},{"issue":"9","key":"ref39","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1016\/0277-9536(95)00061-B","volume":"41","author":"Makoul, G","year":"1995","journal-title":"Soc Sci Med"},{"key":"ref40","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2008.11.015"},{"key":"ref41","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-015959"},{"key":"ref42","doi-asserted-by":"publisher","DOI":"10.2196\/19794"}],"container-title":["JMIR Formative Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/formative.jmir.org\/2023\/1\/e43738","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:46:28Z","timestamp":1782841588000},"score":1,"resource":{"primary":{"URL":"https:\/\/formative.jmir.org\/2023\/1\/e43738"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,7]]},"references-count":42,"URL":"https:\/\/doi.org\/10.2196\/43738","relation":{"has-preprint":[{"id-type":"doi","id":"10.2196\/preprints.43738","asserted-by":"object"}]},"ISSN":["2561-326X"],"issn-type":[{"value":"2561-326X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,7]]}}}