Donovan T Maust1,2,3, Linda Takamine2, Ilse R Wiechers4,5,6, Frederic C Blow7,2,3, Amy S B Bohnert2,3,8, Julie Strominger2, Lillian Min2,3,9, Sarah L Krein2,3,9. 1. Department of Psychiatry, University of Michigan, Ann Arbor, Michigan maustd@umich.edu. 2. Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan. 3. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan. 4. Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, West Haven, Connecticut. 5. Department of Psychiatry, University of California San Francisco, San Francisco, California. 6. Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut. 7. Department of Psychiatry, University of Michigan, Ann Arbor, Michigan. 8. Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan. 9. Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Abstract
PURPOSE: Unlike in many community-based settings, benzodiazepine (BZD) prescribing to older veterans has decreased. We sought to identify health care system strategies associated with greater facility-level reductions in BZD prescribing to older adults. METHODS: We completed an explanatory sequential mixed methods study of health care facilities in the Veterans Health Administration (N = 140). Among veterans aged ≥75 years receiving long-term BZD treatment, we stratified facilities into relatively high and low performance on the basis of the reduction in average daily dose of prescribed BZD from October 1, 2015 to June 30, 2017. We then interviewed key facility informants (n = 21) who led local BZD reduction efforts (champions), representing 11 high-performing and 6 low-performing facilities. RESULTS: Across all facilities, the age-adjusted facility-level average daily dose in October 2015 began at 1.34 lorazepam-equivalent mg/d (SD 0.17); the average rate of decrease was -0.27 mg/d (SD 0.09) per year. All facilities interviewed, regardless of performance, used passive strategies primarily consisting of education regarding appropriate prescribing, alternatives, and identifying potential patients for discontinuation. In contrast, champions at high-performing facilities described leveraging ≥1 active strategies that included individualized recommendations, administrative barriers to prescribing, and performance measures to incentivize clinicians. CONCLUSIONS: Initiatives to reduce BZD prescribing to older adults that are primarily limited to passive strategies, such as education and patient identification, might have limited success. Clinicians might benefit from additional recommendations, support, and incentives to modify prescribing practices.
PURPOSE: Unlike in many community-based settings, benzodiazepine (BZD) prescribing to older veterans has decreased. We sought to identify health care system strategies associated with greater facility-level reductions in BZD prescribing to older adults. METHODS: We completed an explanatory sequential mixed methods study of health care facilities in the Veterans Health Administration (N = 140). Among veterans aged ≥75 years receiving long-term BZD treatment, we stratified facilities into relatively high and low performance on the basis of the reduction in average daily dose of prescribed BZD from October 1, 2015 to June 30, 2017. We then interviewed key facility informants (n = 21) who led local BZD reduction efforts (champions), representing 11 high-performing and 6 low-performing facilities. RESULTS: Across all facilities, the age-adjusted facility-level average daily dose in October 2015 began at 1.34 lorazepam-equivalent mg/d (SD 0.17); the average rate of decrease was -0.27 mg/d (SD 0.09) per year. All facilities interviewed, regardless of performance, used passive strategies primarily consisting of education regarding appropriate prescribing, alternatives, and identifying potential patients for discontinuation. In contrast, champions at high-performing facilities described leveraging ≥1 active strategies that included individualized recommendations, administrative barriers to prescribing, and performance measures to incentivize clinicians. CONCLUSIONS: Initiatives to reduce BZD prescribing to older adults that are primarily limited to passive strategies, such as education and patient identification, might have limited success. Clinicians might benefit from additional recommendations, support, and incentives to modify prescribing practices.
Authors: Donovan T Maust; H Myra Kim; Ilse R Wiechers; Rosalinda V Ignacio; Amy S B Bohnert; Frederic C Blow Journal: J Am Geriatr Soc Date: 2020-09-20 Impact factor: 5.562