Abstract：
Many strategies aimed at deprescribing benzodiazepine receptor agonists (BZRA) in older adults have already been evaluated with various success rates. There is so far no consensus on which strategy components increase deprescribing the most. Yet, despite an unfavourable benefit-to-risk ratio, BZRA use among older adults remains high. We systematically reviewed barriers and enablers for BZRA deprescribing in older adults.
Two reviewers independently screened records identified from five electronic databases-Medline, Embase, PsycINFO, CINAHL and the Cochrane library-and published before October 2020. They searched for grey literature using Google Scholar. Qualitative and quantitative records reporting data on the attitudes of older adults, caregivers and healthcare providers towards BZRA deprescribing were included. Populations at the end of life or with specific psychiatric illness, except for dementia, were excluded. The two reviewers independently assessed the quality of the included studies using the mixed-methods appraisal tool. Barriers and enablers were identified and then coded into domains of the theoretical domains framework (TDF) using a combination of deductive and inductive qualitative analysis. The most relevant TDF domains for BZRA deprescribing were then identified.
Twenty-three studies were included 13 quantitative, 8 qualitative and 2 mixed-method studies. The points of view of older adults, general practitioners and nurses were reported in 19, 9 and 3 records, respectively. We identified barriers and enablers in the majority of TDF domains and in two additional themes: \"patient characteristics\" and \"BZRA prescribing patterns\". Overall, the most relevant TDF domains were \"beliefs about capabilities\", \"beliefs about consequences\", \"environmental context and resources\", \"intention\", \"goals\", \"social influences\", \"memory, attention and decision processes\". Perceived barriers and enablers within domains differed across settings and across stakeholders.
The relevant TDF domains we identified can now be linked to behavioural change techniques to help in the design of future strategies and health policies. Future studies should also assess barriers and enablers perceived by under-evaluated stakeholders (such as pharmacists, psychiatrists and health care professionals in the hospital setting).
This work was registered on PROSPERO under the title \"Barriers and enablers to benzodiazepine receptor agonists deprescribing\".
CRD42020213035.
Two reviewers independently screened records identified from five electronic databases-Medline, Embase, PsycINFO, CINAHL and the Cochrane library-and published before October 2020. They searched for grey literature using Google Scholar. Qualitative and quantitative records reporting data on the attitudes of older adults, caregivers and healthcare providers towards BZRA deprescribing were included. Populations at the end of life or with specific psychiatric illness, except for dementia, were excluded. The two reviewers independently assessed the quality of the included studies using the mixed-methods appraisal tool. Barriers and enablers were identified and then coded into domains of the theoretical domains framework (TDF) using a combination of deductive and inductive qualitative analysis. The most relevant TDF domains for BZRA deprescribing were then identified.
Twenty-three studies were included 13 quantitative, 8 qualitative and 2 mixed-method studies. The points of view of older adults, general practitioners and nurses were reported in 19, 9 and 3 records, respectively. We identified barriers and enablers in the majority of TDF domains and in two additional themes: \"patient characteristics\" and \"BZRA prescribing patterns\". Overall, the most relevant TDF domains were \"beliefs about capabilities\", \"beliefs about consequences\", \"environmental context and resources\", \"intention\", \"goals\", \"social influences\", \"memory, attention and decision processes\". Perceived barriers and enablers within domains differed across settings and across stakeholders.
The relevant TDF domains we identified can now be linked to behavioural change techniques to help in the design of future strategies and health policies. Future studies should also assess barriers and enablers perceived by under-evaluated stakeholders (such as pharmacists, psychiatrists and health care professionals in the hospital setting).
This work was registered on PROSPERO under the title \"Barriers and enablers to benzodiazepine receptor agonists deprescribing\".
CRD42020213035.
摘要：
已经以各种成功率评估了许多旨在在老年人中停用苯二氮卓受体激动剂（BZRA）的策略。迄今为止，尚未就哪些战略组成部分增加了最令人沮丧的问题达成共识。然而，尽管收益风险比不利，老年人的BZRA使用率仍然很高。我们系统地回顾了老年人BZRA开处方的障碍和促成因素。
两名评审员独立筛选了从五个电子数据库-Medline中确定的记录，Embase,PsycINFO,CINAHL和Cochrane图书馆-并在2020年10月之前出版。他们使用GoogleScholar搜索灰色文献。定性和定量记录报告老年人态度的数据，纳入了BZRA解除处方的护理人员和医疗保健提供者.生命结束时或患有特定精神疾病的人群，除了痴呆症,被排除在外。两位评审员使用混合方法评估工具独立评估了纳入研究的质量。识别障碍和推动者，然后使用演绎和归纳定性分析的组合将其编码到理论域框架（TDF）的域中。然后鉴定用于BZRA去处方的最相关的TDF结构域。
23项研究包括13项定量研究，8项定性研究和2项混合方法研究。老年人的观点，全科医生和护士分别有19、9和3份记录，分别。我们确定了大多数TDF领域的障碍和促成因素，以及两个额外的主题：“患者特征”和“BZRA处方模式”。总的来说,最相关的TDF领域是“关于能力的信念”，“关于后果的信念”，“环境背景和资源”，“意向”，“目标”，“社会影响”，\"记忆，注意和决策过程\“。域内感知到的障碍和促成因素因设置和利益相关者而异。
我们确定的相关TDF领域现在可以与行为改变技术联系起来，以帮助设计未来的战略和卫生政策。未来的研究还应评估评估不足的利益相关者(如药剂师、医院环境中的精神科医生和医疗保健专业人员)。
这项工作在PROSPERO上注册，标题为“苯二氮卓受体激动剂开处方的障碍和推动者”。
CRD42020213035。
两名评审员独立筛选了从五个电子数据库-Medline中确定的记录，Embase,PsycINFO,CINAHL和Cochrane图书馆-并在2020年10月之前出版。他们使用GoogleScholar搜索灰色文献。定性和定量记录报告老年人态度的数据，纳入了BZRA解除处方的护理人员和医疗保健提供者.生命结束时或患有特定精神疾病的人群，除了痴呆症,被排除在外。两位评审员使用混合方法评估工具独立评估了纳入研究的质量。识别障碍和推动者，然后使用演绎和归纳定性分析的组合将其编码到理论域框架（TDF）的域中。然后鉴定用于BZRA去处方的最相关的TDF结构域。
23项研究包括13项定量研究，8项定性研究和2项混合方法研究。老年人的观点，全科医生和护士分别有19、9和3份记录，分别。我们确定了大多数TDF领域的障碍和促成因素，以及两个额外的主题：“患者特征”和“BZRA处方模式”。总的来说,最相关的TDF领域是“关于能力的信念”，“关于后果的信念”，“环境背景和资源”，“意向”，“目标”，“社会影响”，\"记忆，注意和决策过程\“。域内感知到的障碍和促成因素因设置和利益相关者而异。
我们确定的相关TDF领域现在可以与行为改变技术联系起来，以帮助设计未来的战略和卫生政策。未来的研究还应评估评估不足的利益相关者(如药剂师、医院环境中的精神科医生和医疗保健专业人员)。
这项工作在PROSPERO上注册，标题为“苯二氮卓受体激动剂开处方的障碍和推动者”。
CRD42020213035。
