Study, Mar/23: Barriers and enablers towards benzodiazepine-receptor agonists deprescribing in nursing homes: A qualitative study of stakeholder groups

[[La...]]

 

Barriers and enablers towards benzodiazepine-receptor agonists deprescribing in nursing homes: A qualitative study of stakeholder groups

 

Abstract

Background: Despite recommendations to deprescribe chronic benzodiazepine receptor agonists (BZRA) among older adults, the prevalence of their use in Belgian nursing homes (NHs) remains above 50%. The use of a behavioral science approach, starting with the evaluation of barriers and enablers for BZRA deprescribing, has the potential to decrease BZRA prescribing.

Objectives: To identify barriers and enablers for BZRA deprescribing perceived by the different stakeholders involved in nursing home care in Belgium.

Methods: In a purposive sample of 6 NHs, we conducted face-to-face interviews with general practitioners (GPs), and focus groups with other healthcare providers (HCPs), including nurses, pharmacists, occupational therapists, physical therapists, and with NH residents and relatives. All interviews with HCPs were analyzed through deductive thematic analysis, using the theoretical domains framework (TDF) as the coding framework. Residents' and relatives' interviews were analyzed using an inductive thematic approach.

Results: We interviewed 13 GPs, 35 other HCPs, 22 nursing home residents, and 5 relatives. Overall, 9 TDF domains were identified as most relevant among HCPs interviewed: Skills, Beliefs about capabilities, Goals, Memory attention and decision processes, Environmental context and resources, Social influences, Knowledge, Social/professional role and identity, and Beliefs about consequences. Five additional themes emerged from residents' and relatives' interviews: knowledge on medications used, communication with NH staff and GPs, perceived efficacy and necessity of BZRA, influence of the environment, and reluctance towards BZRA deprescribing. Some domains and themes differ between stakeholders (e.g., knowledge), while others match between groups (e.g., environmental aspects).

Conclusion: BZRA deprescribing is influenced by knowledge and skills gaps, automatic BZRA refilling, competing priorities, social challenges, environmental factors and poor nursing home residents involvement. Targeting these barriers will be a key step for implementation of BZRA deprescribing.

Full Paper:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10130691/

 

 

[[Ka...]]

I’ve been thinking a lot about prescribing/deprescribing in nursing/care home sector. In UK, my late mother was moved from hospital to a nursing home. Then under the care of the local doctor who reviewed her medication. After a week, and with dementia and in a new setting, she became extremely agitated. It transpired her medicine (I can’t be sure which benzodiazepine) was stopped abruptly. I know there is concern re falls and so this is complex. But she was then put back onto her benzo and reverted to usual self. Years later, she was prescribed diazepam on prn basis and I now realise how that made her suffer.  I wish I had known more at that time. 

Edited February 4 by [Ka...]

[[Li...]]

Hello @[Ka...].  Thank you for sharing your late mother’s story with us.  I’m working on a piece about the risks of deprescribing benzodiazepines in older adults so it resonated with me.  

You are clearly a caring and observant daughter.  Did you see signs that the PRN dosing of diazepam was causing your mother issues?  If not, she may have been ok with it.  As I’m sure you’ve read, some individuals are able to start and stop benzodiazepines without negative consequences. 

[[Ka...]]

Thank you @[Li...] This is a sensitive topic. What I’ve witnessed in nursing/care home sector here is control & people need an advocate. I tried but failed for a number of reasons. 

Yes, sadly would often find her frantic and I think prn didn’t suit her needs. My visits were all about trying to calm her. And check up on care too. 
The reason it is hard is I have ptsd as a result of this and another trauma and was given benzos. So there is a correlation. Diazepam made me pace just as she did. 
Certainly a lesson. I see it clearly in retrospect. 
Your piece sounds very relevant and much needed. 
 

[[Li...]]

 

Oh dear @[Ka...].  I’m so sorry to learn this —  what a heart-wrenching, devastating experience for both you and your mother.

This is indeed a sensitive subject but it’s one that warrants increased attention on the part of researchers, advocacy groups, policymakers, healthcare professionals, service users and society. 

 

[[ha...]]

@[Ka...] I'm sorry your mother suffered and that you also know what it is.

Your story reminded me how much we depend on other people's decisions, especially when it comes to health issues.

My grandmother has health issues and requires constant help. I had to address thekey customer service yesterday to find a home caregiver for her. It breaks my heart as I remember her as an active woman and it is hard to see her in this condition.

Edited February 14 by [ha...]