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Exploration of Barriers and Facilitators for Deprescribing Opioids and Benzodiazepines to Reduce Older Adult Falls

As part of a randomized control trial for deprescribing opioids and benzodiazepines (BZD) to reduce falls (funded by Centers for Disease Control), we conducted a virtual focus group and surveys to evaluate opioid and BZD prescribing practices among healthcare providers in four primary care clinics i...

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Autores principales: Roberts, Ellen, Henage, Cristine, Armistead, Lori, Hughes, Tamera, Niznik, Joshua, Schlusser, Courtney, Busby-Whitehead, Jan, Ferreri, Stefanie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7741467/
http://dx.doi.org/10.1093/geroni/igaa057.3332
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author Roberts, Ellen
Henage, Cristine
Armistead, Lori
Hughes, Tamera
Niznik, Joshua
Schlusser, Courtney
Busby-Whitehead, Jan
Ferreri, Stefanie
author_facet Roberts, Ellen
Henage, Cristine
Armistead, Lori
Hughes, Tamera
Niznik, Joshua
Schlusser, Courtney
Busby-Whitehead, Jan
Ferreri, Stefanie
author_sort Roberts, Ellen
collection PubMed
description As part of a randomized control trial for deprescribing opioids and benzodiazepines (BZD) to reduce falls (funded by Centers for Disease Control), we conducted a virtual focus group and surveys to evaluate opioid and BZD prescribing practices among healthcare providers in four primary care clinics in North Carolina. Survey and focus group questions measured providers’ confidence in their abilities to weigh benefits and harms of opioids and/or BZDs in older adults; determine alternative interventions; create a safe dosing plan; and incorporate patient preferences. A validated pre-intervention survey, adapted from a survey by the Canadian Deprescribing Network, was administered to providers in control and intervention clinics (n=29). Providers expressed high confidence in their abilities to weigh risks and benefits of deprescribing opioids and BZDs, but low confidence in deprescribing under impeding circumstances (e.g. when not the original prescriber or when there is no evidence to inform them). Results were similar across opioids and BZDs. A focus group was conducted among seven providers from the two intervention clinics. Barriers to deprescribing identified included patient resistance, lack of knowledge of deprescribing best practices, and lack of time to discuss deprescribing during regular clinic visits. Providers also expressed concerns about deprescribing medications initiated by or managed by other prescribers. Key facilitators of deprescribing included patient trust in physician, patients being agreeable to reduce medications, and use of gradual tapering rather than abrupt discontinuation. Barriers and facilitators were subsequently used to optimize training and provider resources for the deprescribing intervention, which is currently being implemented.
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spelling pubmed-77414672020-12-21 Exploration of Barriers and Facilitators for Deprescribing Opioids and Benzodiazepines to Reduce Older Adult Falls Roberts, Ellen Henage, Cristine Armistead, Lori Hughes, Tamera Niznik, Joshua Schlusser, Courtney Busby-Whitehead, Jan Ferreri, Stefanie Innov Aging Abstracts As part of a randomized control trial for deprescribing opioids and benzodiazepines (BZD) to reduce falls (funded by Centers for Disease Control), we conducted a virtual focus group and surveys to evaluate opioid and BZD prescribing practices among healthcare providers in four primary care clinics in North Carolina. Survey and focus group questions measured providers’ confidence in their abilities to weigh benefits and harms of opioids and/or BZDs in older adults; determine alternative interventions; create a safe dosing plan; and incorporate patient preferences. A validated pre-intervention survey, adapted from a survey by the Canadian Deprescribing Network, was administered to providers in control and intervention clinics (n=29). Providers expressed high confidence in their abilities to weigh risks and benefits of deprescribing opioids and BZDs, but low confidence in deprescribing under impeding circumstances (e.g. when not the original prescriber or when there is no evidence to inform them). Results were similar across opioids and BZDs. A focus group was conducted among seven providers from the two intervention clinics. Barriers to deprescribing identified included patient resistance, lack of knowledge of deprescribing best practices, and lack of time to discuss deprescribing during regular clinic visits. Providers also expressed concerns about deprescribing medications initiated by or managed by other prescribers. Key facilitators of deprescribing included patient trust in physician, patients being agreeable to reduce medications, and use of gradual tapering rather than abrupt discontinuation. Barriers and facilitators were subsequently used to optimize training and provider resources for the deprescribing intervention, which is currently being implemented. Oxford University Press 2020-12-16 /pmc/articles/PMC7741467/ http://dx.doi.org/10.1093/geroni/igaa057.3332 Text en © The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstracts
Roberts, Ellen
Henage, Cristine
Armistead, Lori
Hughes, Tamera
Niznik, Joshua
Schlusser, Courtney
Busby-Whitehead, Jan
Ferreri, Stefanie
Exploration of Barriers and Facilitators for Deprescribing Opioids and Benzodiazepines to Reduce Older Adult Falls
title Exploration of Barriers and Facilitators for Deprescribing Opioids and Benzodiazepines to Reduce Older Adult Falls
title_full Exploration of Barriers and Facilitators for Deprescribing Opioids and Benzodiazepines to Reduce Older Adult Falls
title_fullStr Exploration of Barriers and Facilitators for Deprescribing Opioids and Benzodiazepines to Reduce Older Adult Falls
title_full_unstemmed Exploration of Barriers and Facilitators for Deprescribing Opioids and Benzodiazepines to Reduce Older Adult Falls
title_short Exploration of Barriers and Facilitators for Deprescribing Opioids and Benzodiazepines to Reduce Older Adult Falls
title_sort exploration of barriers and facilitators for deprescribing opioids and benzodiazepines to reduce older adult falls
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7741467/
http://dx.doi.org/10.1093/geroni/igaa057.3332
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