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

Perrine Evrard; Amber Damiaens; Andrea M Patey; Jeremy M Grimshaw; Anne Spinewine

doi:10.1016/j.rcsop.2023.100258

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

Explor Res Clin Soc Pharm. 2023 Mar 31:9:100258. doi: 10.1016/j.rcsop.2023.100258. eCollection 2023 Mar.

Authors

Perrine Evrard¹, Amber Damiaens², Andrea M Patey³, Jeremy M Grimshaw^{3

4}, Anne Spinewine^{1

5}

Affiliations

¹ Clinical Pharmacy Research group, Louvain Drug Research Institute, UCLouvain, Brussels, Belgium - 72/B1.72.02 Avenue Emmanuel Mounier, Bruxelles 1200, Belgium.
² Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium. - ON2 Herestraat 49 - Box 424, Leuven 3000, Belgium.
³ Centre for Implementation Research, Ottawa Hospital Research Institute - General Campus, Ottawa, Ontario, Canada - 501, ch. Smyth Road, L1255, Box/C.P. 711, Ottawa, ON K1H 8L6, Canada.
⁴ Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada - Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON K1H 8M5, Canada.
⁵ Pharmacy Department, CHU UCL Namur, Yvoir, Belgium - Rue Dr Gaston Therasse 1, Yvoir 5530, Belgium.

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.

Keywords: Barriers and enablers; Benzodiazepines; Deprescribing; Nursing home; Qualitative study.