Barriers and Facilitators to the Deprescribing of Nonbenzodiazepine Sedative Medications Among Older Adults

Kuntz, Jennifer L; Kouch, Louis; Christian, Daniel; Peterson, Preston L; Gruß, Inga

doi:10.7812/tpp/17-157

Cited by 34 publications

(40 citation statements)

References 16 publications

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“…In spite of these risks and recommendations, more than 40% of older patients receive sleep‐inducing drugs during their hospital stay . We know some of the reasons for this prescribing behavior: for example, professional knowledge deficits, a perceived lack of alternative treatment options for sleep problems, and the “magic bullet” potential of benzodiazepines and Z‐drugs to help patients “feel better overall.” Physicians may also regard other medical issues with higher priority than the control and restriction of sleep‐inducing drugs …”

Section: Introductionmentioning

confidence: 99%

Patient‐reported factors associated with the desire to continue taking sleep‐inducing drugs after hospital discharge: A survey of older adults

Heinemann

Neukirchen

Nau

et al. 2019

Pharmacoepidemiology and Drug

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Purpose To find out whether any prior experiences with sleep‐inducing drugs before hospitalization and positive experiences with these drugs during hospitalization influence a patient's wish to continue taking sleep‐inducing drugs after hospitalization. Methods We surveyed older hospital patients about use of sleep‐inducing drugs before, during, and after hospitalization and compared these answers with their hospital chart using the kappa statistic. The association between the wish to continue these drugs after discharge and the perceived benefits, experience of side effects, and prior experience with sleep‐inducing drugs was determined by multivariable logistic regression. Results Agreement between patient responses and the hospital file was high (κ = 0.7). Seventeen percent (83/483) of the participants reported prior experience before their hospital stay; 45% received a sleep‐inducing drug during hospitalization; 17% wished to continue taking them after discharge. Of the 400 patients who had no prior experience with sleep‐inducing drugs, 147 (37%) became first‐time users in the hospital, and 27% (40/147) of these wished to continue this medication after discharged. Strong predictors for this wish were the reduction of sleep onset problems (adjusted odds ratio, 6.26; 95% confidence interval, 2.38‐16.44) and any prior experience with sleep‐inducing drugs (4.08; 1.97‐8.48). Conclusions Many older patients become first‐time users of sleep‐inducing drugs in the hospital. Especially the experience of sleep onset improvements influences the wish to continue sleep‐inducing drug use after discharge. Avoiding first‐time use should become a goal of hospital policy and be taken into account when weighing the benefits and risks of sleep‐inducing drugs.

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Section: Introductionmentioning

confidence: 99%

Patient‐reported factors associated with the desire to continue taking sleep‐inducing drugs after hospital discharge: A survey of older adults

Heinemann

Neukirchen

Nau

et al. 2019

Pharmacoepidemiology and Drug

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“…However, identifying effective strategies to urge prescribers to dose reduce and/or deprescribe opioids and benzodiazepines is not without its challenges. Barriers still remain such as employing effective communication channels to ensure receipt of the pharmacist's recommendations, prescriber knowledge regarding patients' risk for adverse drug events, and lack of resources and institutional support for deprescribing and providing viable alternatives [18].…”

Section: Discussionmentioning

confidence: 99%

“…However, some patients still may resist deprescribing if they feel the health condition that they were using drugs to manage is critical to effective symptom management and their current treatment. In a recent study, patients expressed healthcare system factors and positive personal experiences with sedative medication usage as reasons for disputing providers' recommendation to deprescribe while being concerned about safe alternatives [18]. Yet, numerous, viable alternatives exist rather than relying on co-prescribing opioids and benzodiazepines.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, another study found that pharmacists with chronic pain used a mean of 13 ± 5 pharmacological and non-pharmacological management strategies, while some used as many as 31 different ones [20]. Additionally, direct-to-patient educational interventions may provide promising opportunities, especially when coupled with individualized care [18].…”

Section: Discussionmentioning

confidence: 99%

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Preliminary Investigation of Pharmacist-Delivered, Direct-to-Provider Interventions to Reduce Co-Prescribing of Opioids and Benzodiazepines among a Medicare Population

Bingham¹,

Taylor

Boesen³

et al. 2020

Pharmacy

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Co-prescribing of opioids and benzodiazepines can lead to overdoses and mortality. This retrospective study analyzed prescription claims data collected in 2016. A national medication therapy management (MTM) program conducted prescriber-based outreach interventions for patients with concurrent opioid and benzodiazepine prescriptions. The pharmacist’s direct-to-prescriber intervention was conducted following a targeted medication review. The pharmacist initiated interventions with the prescriber via facsimile to recommend discontinuation of concurrent use of these drugs. This study included 57,748 subjects who were predominantly female (67.83%) and aged ≥ 65 years (66.90%). Prescribers were most commonly located in the southern United States (46.88%). The top prescribed opioid medications were hydrocodone-acetaminophen (33.60%), tramadol (17.50%), and oxycodone-acetaminophen (15.66%). The top benzodiazepines prescribed concurrently with opioids were alprazolam (35.11%), clonazepam (21.16%), and lorazepam (20.09%). Based on the pharmacists’ recommendations, 37,990 (65.79%) resulted in a medication discontinuation (benzodiazepines 40.23%; opioids 59.77%) by the provider. There were significant differences in the proportion of opioids discontinued by subject age (p < 0.001) and prescriber geographical region (p = 0.0148). The top medications discontinued by the prescriber were hydrocodone-acetaminophen (18.86%), alprazolam (14.19%), and tramadol HCl (13.51%). This study provides initial evidence for pharmacist-supported, direct-to-prescriber programs as an effective medication safety strategy.

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“…16 System-related factors include uncoordinated delivery of health services, prescribers'attitudes and/or experience, limited availability of guidelines for deprescribing, lack of evidence on preventative therapy. 11,12,17,18 Healthcare in Canada is delivered provincially, and each province has their own procedures in place. However, a commonality within the provinces is that care is given in isolation depending on levels of care (primary care, secondary care, tertiary care, and quaternary care) and communication gaps exist between healthcare practitioners.…”

Section: Deprescribing Barriers Prior To Covid-19mentioning

confidence: 99%

Barriers to conducting deprescribing in the elderly population amid the COVID-19 pandemic

Elbeddini

Prabaharan

Almasalkhi

et al. 2021

Research in Social and Administrative Pharmacy

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Deprescribing aims to reduce polypharmacy, especially in the elderly population, in order to maintain or improve quality of life, reduce harm from medications, and limit healthcare expenditure. Coronavirus disease (COVID-19) is an infectious disease that has led to a pandemic and has changed the lives many throughout the world. The mode of transmission of this virus is from person to person through the transfer of respiratory droplets. Therefore, non-essential healthcare services involving direct patient interactions, including deprescribing, has been on hiatus to reduce spread. Barriers to deprescribing before the pandemic include patient and system related factors, such as resistance to change, patient's knowledge deficit about deprescribing, lack of alternatives for treatment of disease, uncoordinated delivery of health services, prescriber's attitudes and/or experience, limited availability of guidelines for deprescribing, and lack of evidence on preventative therapy. Some of these barriers can be mitigated by using the following interventions:patient education, prioritization of non-pharmacological therapy, incorporation of electronic health record (EHR), continuous prescriber education, and development of research studies on deprescribing. Currently, deprescribing cannot be delivered through in person interactions, so virtual care is a reasonable alternative format. The full incorporation of EHR throughout Canada can add to the success of this strategy. However, there are several challenges of conducting deprescribing virtually in the elderly population. These challenges include, but are not limited, to their inability to use technology, lack of literacy, lack of assistance from others, greater propensity for withdrawal effects, and increased risk of severe consequences, if hospitalized. Virtual care is the future of healthcare and in order to retain the benefits of deprescribing, additional initiatives should be in place to address the challenges that elderly patients may experience in accessing deprescribing virtually. These initiatives should involve teaching elderly patients how to use technology to access health services and with technical support in place to address any concerns.

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Barriers and Facilitators to the Deprescribing of Nonbenzodiazepine Sedative Medications Among Older Adults

Cited by 34 publications

References 16 publications

Patient‐reported factors associated with the desire to continue taking sleep‐inducing drugs after hospital discharge: A survey of older adults

Patient‐reported factors associated with the desire to continue taking sleep‐inducing drugs after hospital discharge: A survey of older adults

Preliminary Investigation of Pharmacist-Delivered, Direct-to-Provider Interventions to Reduce Co-Prescribing of Opioids and Benzodiazepines among a Medicare Population

Barriers to conducting deprescribing in the elderly population amid the COVID-19 pandemic

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