Learning about blended care: is communication key?: Presenter(s): Kristien Coteur, KU Leuven, Belgium

In Belgium, there is a well-known problem of overuse of sleeping pills, benzodiazepines and z-drugs (BZRA). To obtain this medication, patients need a prescription from their treating physician, which is mostly their general practitioner (GP). Although GPs generally are aware of the problematic overconsumption, they find it difficult to manage the decrease and stopping of BZRA. Given the success of blended care for the treatment of sleeping disorders and the support of substance use disorders, research suggests that a blended care approach, combining in-person treatment by the GP with web-based self-learning by the patient, could be beneficial for the discontinuation of chronic benzodiazepine use for primary insomnia in general practice. Our study aimed to evaluate the implementation process of a blended care approach for the discontinuation of BZRA use in the long term (12 months) as assessed by toxicological screening. Multi-faceted evaluation of a multicentre, pragmatic, cluster randomised controlled trial, with a mixed method design, inspired by the framework of Grant et al. (2013) for process evaluations of cluster-randomised trials of complex interventions. Data was collected through an online survey (76 respondents), interviews with patient (18 respondents), focus groups with GPs (19 respondents), and a usage logbook of the online intervention. Inductive qualitative content analysis was used. Communication was important in every stage of implementation, from recruitment, over delivery of the intervention, to follow-up. For patients, support from the GP and discussing the next step were crucial elements to take action and stay motivated. Diversity among patients and care providers requires differentiation, for which blended care is an added value. However, the e-tool in blended care cannot stand alone. Regular communication and feedback between patient and care provider is crucial to benefit from this approach.