Jennifer Kuntz1, Louis Kouch2, Daniel Christian3, Preston L Peterson4, Inga Gruss5. 1. Assistant Investigator at the Center for Health Research in Portland, OR. jennifer.l.kuntz@kpchr.org. 2. Pharmacy Resident in the Department of Clinical Pharmacy Services for Kaiser Permanente Northwest in Portland, OR. louis.j.kouch@kp.org. 3. Regional Drug Education Coordinator in the Department of Clinical Pharmacy Services for Kaiser Permanente Northwest in Portland, OR. daniel.a.christian@kp.org. 4. Regional Chief of Geriatrics in the Division of Continuing Care Services for Kaiser Permanente Northwest in Portland, OR. preston.lane.peterson@kp.org. 5. Research Associate at the Center for Health Research in Portland, OR. inga.gruss@kpchr.org.
Abstract
INTRODUCTION: Nonbenzodiazepine sedative-hypnotic medications, or "Z-drugs," are commonly used to treat insomnia among older adults (≥ 65 years), despite a lack of evidence of long-term effectiveness and evidence linking long-term use with poor outcomes. OBJECTIVE: To understand patient and clinician barriers and facilitators to deprescribing, or discontinuation, of Z-drugs. METHODS: We conducted a qualitative interview study among older adults who received a deprescribing intervention and among their clinicians at Kaiser Permanente Northwest. Semistructured interviews explored perceived barriers and facilitators to successful deprescribing of Z-drugs. Interviews were audiorecorded with participant permission. Content was analyzed using QSR NVivo 10 software. RESULTS: From the perspectives of patients, the greatest challenges to deprescribing are factors related to their insomnia, including the need for effective treatment of their insomnia; health care system factors, including a desire for personalized approaches to care; and their own positive personal experiences with sedative medication use. From the clinician perspective, a lack of institutional structures and resources to support deprescribing, the attitudes and practices of previous clinicians, and patient-related factors such as dependence and a lack of alternatives to treat insomnia were the most important barriers to deprescribing. CONCLUSIONS: Health care systems must provide individualized care that supports patient goals for restful sleep and quality of life while also providing evidence-based care that takes patient safety into account. To accomplish this, systems must support patients and clinicians and provide a multidisciplinary approach that addresses insomnia treatment, provides patient education about sedative medication use, and supports the discontinuation process.
INTRODUCTION:Nonbenzodiazepine sedative-hypnotic medications, or "Z-drugs," are commonly used to treat insomnia among older adults (≥ 65 years), despite a lack of evidence of long-term effectiveness and evidence linking long-term use with poor outcomes. OBJECTIVE: To understand patient and clinician barriers and facilitators to deprescribing, or discontinuation, of Z-drugs. METHODS: We conducted a qualitative interview study among older adults who received a deprescribing intervention and among their clinicians at Kaiser Permanente Northwest. Semistructured interviews explored perceived barriers and facilitators to successful deprescribing of Z-drugs. Interviews were audiorecorded with participant permission. Content was analyzed using QSR NVivo 10 software. RESULTS: From the perspectives of patients, the greatest challenges to deprescribing are factors related to their insomnia, including the need for effective treatment of their insomnia; health care system factors, including a desire for personalized approaches to care; and their own positive personal experiences with sedative medication use. From the clinician perspective, a lack of institutional structures and resources to support deprescribing, the attitudes and practices of previous clinicians, and patient-related factors such as dependence and a lack of alternatives to treat insomnia were the most important barriers to deprescribing. CONCLUSIONS: Health care systems must provide individualized care that supports patient goals for restful sleep and quality of life while also providing evidence-based care that takes patient safety into account. To accomplish this, systems must support patients and clinicians and provide a multidisciplinary approach that addresses insomnia treatment, provides patient education about sedative medication use, and supports the discontinuation process.
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