Identifying barriers and facilitators to deprescribing benzodiazepines and sedative hypnotics in the hospital setting using the Theoretical Domains Framework and the Capability, Opportunity, Motivation and Behaviour (COM-B) Model: a qualitative study

Michelle S Keller; Johan Carrascoza-Bolanos; Kathleen Breda; Linda Y Kim; Korey A Kennelty; Donna W Leang; Logan T Murry; Teryl K Nuckols; Jeffrey L Schnipper; Joshua M Pevnick

doi:10.1136/bmjopen-2022-066234

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Identifying barriers and facilitators to deprescribing benzodiazepines and sedative hypnotics in the hospital setting using the Theoretical Domains Framework and the Capability, Opportunity, Motivation and Behaviour (COM-B) Model: a qualitative study

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Identifying barriers and facilitators to deprescribing benzodiazepines and sedative hypnotics in the hospital setting using the Theoretical Domains Framework and the Capability, Opportunity, Motivation and Behaviour (COM-B) Model: a qualitative study

Michelle S Keller, Johan Carrascoza-Bolanos, Kathleen Breda, Linda Y Kim, Korey A Kennelty, Donna W Leang, Logan T Murry, Teryl K Nuckols, Jeffrey L Schnipper and Joshua M Pevnick

BMJ open, Vol.13(2), pp.e066234-e066234

02/22/2023

DOI: 10.1136/bmjopen-2022-066234

PMCID: PMC9950911

PMID: 36813499

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Abstract

Geriatric guidelines strongly recommend avoiding benzodiazepines and non-benzodiazepine sedative hypnotics in older adults. Hospitalisation may provide an important opportunity to begin the process of deprescribing these medications, particularly as new contraindications arise. We used implementation science models and qualitative interviews to describe barriers and facilitators to deprescribing benzodiazepines and non-benzodiazepine sedative hypnotics in the hospital and develop potential interventions to address identified barriers. We used two implementation science models, the Capability, Opportunity and Behaviour Model (COM-B) and the Theoretical Domains Framework, to code interviews with hospital staff, and an implementation process, the Behaviour Change Wheel (BCW), to codevelop potential interventions with stakeholders from each clinician group. Interviews took place in a tertiary, 886-bed hospital located in Los Angeles, California. Interview participants included physicians, pharmacists, pharmacist technicians, and nurses. We interviewed 14 clinicians. We found barriers and facilitators across all COM-B model domains. Barriers included lack of knowledge about how to engage in complex conversations about deprescribing (capability), competing tasks in the inpatient setting (opportunity), high levels of resistance/anxiety among patients to deprescribe (motivation), concerns about lack of postdischarge follow-up (motivation). Facilitators included high levels of knowledge about the risks of these medications (capability), regular rounds and huddles to identify inappropriate medications (opportunity) and beliefs that patients may be more receptive to deprescribing if the medication is related to the reason for hospitalisation (motivation). Potential modes of delivery included a seminar aimed at addressing capability and motivation barriers in nurses, a pharmacist-led deprescribing initiative using risk stratification to identify and target patients at highest need for deprescribing, and the use of evidence-based deprescribing education materials provided to patients at discharge. While we identified numerous barriers and facilitators to initiating deprescribing conversations in the hospital, nurse- and pharmacist-led interventions may be an appropriate opportunity to initiate deprescribing.

Aftercare

Aged

Benzodiazepines

Deprescriptions

Hospitals

Humans

Hypnotics and Sedatives

Motivation

Patient Discharge

Qualitative Research

Details

Title: Subtitle: Identifying barriers and facilitators to deprescribing benzodiazepines and sedative hypnotics in the hospital setting using the Theoretical Domains Framework and the Capability, Opportunity, Motivation and Behaviour (COM-B) Model: a qualitative study
Creators: Michelle S Keller - Cedars-Sinai Medical Center
Johan Carrascoza-Bolanos - Cedars-Sinai Medical Center
Kathleen Breda - Cedars-Sinai Medical Center
Linda Y Kim - Cedars-Sinai Medical Center
Korey A Kennelty - University of Iowa
Donna W Leang - Cedars-Sinai Medical Center
Logan T Murry - University of Iowa
Teryl K Nuckols - Cedars-Sinai Medical Center
Jeffrey L Schnipper - Brigham and Women's Hospital
Joshua M Pevnick - Cedars-Sinai Medical Center
Resource Type: Journal article
Publication Details: BMJ open, Vol.13(2), pp.e066234-e066234
DOI: 10.1136/bmjopen-2022-066234
PMID: 36813499
PMCID: PMC9950911
NLM abbreviation: BMJ Open
ISSN: 2044-6055
eISSN: 2044-6055
Grant note: R01 AG058911 / NIA NIH HHS
Language: English
Date published: 02/22/2023
Academic Unit: Family and Community Medicine; Pharmacy Practice and Science; Injury Prevention Research Center
Record Identifier: 9984375456402771

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