Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Anna-Von-Krauchthal Weg 7, Bern, 3010, Switzerland.
Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
BMC Geriatr. 2024 May 4;24(1):396. doi: 10.1186/s12877-024-05027-9.
Benzodiazepines and other sedative hypnotic drugs (BSHs) are frequently prescribed for sleep problems, but cause substantial adverse effects, particularly in older adults. Improving knowledge on barriers, facilitators and needs of primary care providers (PCPs) to BSH deprescribing could help reduce BSH use and thus negative effects.
We conducted a mixed methods study (February-May 2023) including a survey, semi-structured interviews and focus groups with PCPs in Switzerland. We assessed barriers, facilitators and needs of PCPs to BSH deprescribing. Quantitative data were analyzed descriptively, qualitative data deductively and inductively using the Theoretical Domain Framework (TDF). Quantitative and qualitative data were integrated using meta-interferences.
The survey was completed by 126 PCPs (53% female) and 16 PCPs participated to a focus group or individual interview. The main barriers to BSH deprescribing included patient and PCP lack of knowledge on BSH effects and side effects, lack of PCP education on treatment of sleep problems and BSH deprescribing, patient lack of motivation, PCP lack of time, limited access to cognitive behavioral therapy for insomnia and absence of public dialogue on BSHs. Facilitators included informing on side effects to motivate patients to discontinue BSHs and start of deprescribing during a hospitalization. Main PCP needs were practical recommendations for pharmacological and non-pharmacological treatment of sleep problems and deprescribing schemes. Patient brochures were wished by 69% of PCPs. PCPs suggested the brochures to contain explanations about risks and benefits of BSHs, sleep hygiene and sleep physiology, alternative treatments, discontinuation process and tapering schemes.
The barriers and facilitators as well as PCP needs and opinions on patient material we identified can be used to develop PCP training and material on BSH deprescribing, which could help reduce the inappropriate use of BSHs for sleep problems.
苯二氮䓬类和其他镇静催眠药物（BSHs）常用于治疗睡眠问题，但会引起大量不良反应，尤其是在老年人中。提高初级保健提供者（PCPs）对 BSH 减药的障碍、促进因素和需求的认识，可以帮助减少 BSH 的使用，从而减少负面影响。
我们在瑞士进行了一项混合方法研究（2023 年 2 月至 5 月），包括对 PCPs 的调查、半结构式访谈和焦点小组。我们评估了 PCPs 对 BSH 减药的障碍、促进因素和需求。定量数据采用描述性分析，定性数据采用理论领域框架（TDF）进行演绎和归纳分析。使用元干扰将定量和定性数据进行整合。
调查由 126 名 PCPs（53%为女性）完成，16 名 PCPs 参加了焦点小组或个人访谈。BSH 减药的主要障碍包括患者和 PCP 对 BSH 作用和副作用的了解不足、缺乏对治疗睡眠问题和 BSH 减药的 PCP 教育、患者缺乏动机、PCP 缺乏时间、获得认知行为疗法治疗失眠的机会有限以及缺乏关于 BSH 的公共对话。促进因素包括告知副作用以激发患者停用 BSH 并开始减药。PCPs 的主要需求包括治疗睡眠问题和减药方案的药理学和非药理学治疗的实用建议。69%的 PCPs 希望有患者手册。PCPs 建议手册中包含关于 BSH 的风险和益处、睡眠卫生和睡眠生理学、替代治疗、停药过程和逐步减少方案的解释。
我们确定的障碍、促进因素以及 PCP 的需求和对患者材料的意见，可以用于开发针对 BSH 减药的 PCP 培训和材料，这有助于减少 BSH 治疗睡眠问题的不当使用。
