初级保健医生对老年人减少开处阿片类药物和苯二氮䓬类药物的看法。
Primary-Care Prescribers' Perspectives on Deprescribing Opioids and Benzodiazepines in Older Adults.
机构信息
Division of Geriatric Medicine, Department of Medicine, University of North Carolina at Chapel Hill, School of Medicine, 5003 Old Clinic, CB# 7550, Chapel Hill, NC, 27599, USA.
UNC Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
出版信息
Drugs Aging. 2022 Sep;39(9):739-748. doi: 10.1007/s40266-022-00967-6. Epub 2022 Jul 28.
PURPOSE
Opioids and benzodiazepines (BZDs) are frequently implicated as contributing to falls in older adults. Deprescribing of these medications continues to be challenging. This study evaluated primary-care prescribers' confidence in and perceptions of deprescribing opioids and BZDs for older adults.
METHODS
For this study, we conducted a quantitative analysis of survey data combined with an analysis of qualitative data from a focus group. A survey evaluating prescriber confidence in deprescribing opioids and BZDs was distributed to providers at 15 primary-care clinics in North Carolina between March-December 2020. Average confidence (scale 0-100) for deprescribing opioids, deprescribing BZDs, and deprescribing under impeding circumstances were reported. A virtual focus group was conducted in March 2020 to identify specific barriers and facilitators to deprescribing opioids and BZDs. Audio recordings and transcripts were analyzed using inductive coding.
RESULTS
We evaluated 61 survey responses (69.3% response rate). Respondents were predominantly physicians (54.8%), but also included nurse practitioners (24.6%) and physician assistants (19.4%). Average overall confidence in deprescribing was comparable for opioids (64.5) and BZDs (65.9), but was lower for deprescribing under impeding circumstances (53.7). In the focus group, prescribers noted they met more resistance when deprescribing BZDs and that issues such as lack of time, availability of mental health resources, and patients seeing multiple prescribers were barriers to deprescribing.
CONCLUSION
Findings from quantitative and qualitative analyses identified that prescribers were moderately confident in their ability to deprescribe both opioids and BZDs in older adults, but less confident under potentially impeding circumstances. Future studies are needed to evaluate policies and interventions to overcome barriers to deprescribing opioids and BZDs in primary care.
目的
阿片类药物和苯二氮䓬类药物（BZDs）经常被认为是导致老年人跌倒的原因。这些药物的停药仍然具有挑战性。本研究评估了初级保健开方者对老年人停用阿片类药物和 BZDs 的信心和看法。
方法
在这项研究中，我们对调查数据进行了定量分析，并结合焦点小组的定性数据分析进行了分析。一项评估开方者停用阿片类药物和 BZDs 信心的调查于 2020 年 3 月至 12 月在北卡罗来纳州的 15 个初级保健诊所向提供者分发。报告了停用阿片类药物、BZDs 和在阻碍情况下停用的平均信心（0-100 分）。2020 年 3 月进行了虚拟焦点小组，以确定停用阿片类药物和 BZDs 的具体障碍和促进因素。使用归纳编码对音频记录和抄本进行了分析。
结果
我们评估了 61 份调查答复（54.6%的答复率）。受访者主要是医生（54.8%），但也包括护士从业者（24.6%）和医师助理（19.4%）。总体而言，停用阿片类药物的信心相当（64.5），BZDs 也相当（65.9），但在阻碍情况下的信心较低（53.7）。在焦点小组中，开方者指出，他们在停用 BZDs 时遇到了更多的阻力，缺乏时间、心理健康资源的可及性以及患者看多个开方者等问题是停用的障碍。
结论
定量和定性分析的结果表明，开方者对自己在老年人中停用阿片类药物和 BZDs 的能力有一定的信心，但在潜在阻碍的情况下信心较低。需要进一步研究评估政策和干预措施，以克服初级保健中停用阿片类药物和 BZDs 的障碍。
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