PDF(Pubmed)
Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：苯二氮卓类药物和其他镇静催眠药物（BSHs）经常用于治疗睡眠问题，但是会造成严重的不良影响，尤其是老年人。提高对障碍的认识，初级保健提供者(PCP)对BSH开处方的促进者和需求有助于减少BSH的使用,从而减少负面影响.
方法：我们进行了一项混合方法研究（2023年2月至5月），其中包括一项调查，与瑞士PCP的半结构化访谈和焦点小组。我们评估了障碍，PCP对BSH处方的促进者和需求。定量数据进行了描述性分析，使用理论域框架(TDF)演绎和归纳的定性数据。定量和定性数据使用元干扰进行整合。
结果：该调查由126名PCP（53％为女性）完成，16名PCP参加了焦点小组或个人访谈。BSH停用药物的主要障碍包括患者和PCP缺乏对BSH作用和副作用的了解，缺乏关于治疗睡眠问题和BSH处方的PCP教育，病人缺乏动力，五氯苯酚缺乏时间，对失眠症的认知行为治疗的机会有限，并且缺乏关于BSH的公开对话。促进者包括告知副作用，以激励患者停止BSH并在住院期间开始开处方。PCP的主要需求是针对睡眠问题的药理学和非药理学治疗以及开处方方案的实用建议。69％的PCP希望患者手册。PCP建议手册包含有关BSH风险和收益的解释，睡眠卫生和睡眠生理学，替代疗法,中止过程和逐渐减少的计划。
结论：我们确定的障碍和促进者以及对患者材料的PCP需求和意见，可用于开发PCP培训和BSH去处方材料，这可以帮助减少BSHs在睡眠问题上的不当使用。
方法：我们进行了一项混合方法研究（2023年2月至5月），其中包括一项调查，与瑞士PCP的半结构化访谈和焦点小组。我们评估了障碍，PCP对BSH处方的促进者和需求。定量数据进行了描述性分析，使用理论域框架(TDF)演绎和归纳的定性数据。定量和定性数据使用元干扰进行整合。
结果：该调查由126名PCP（53％为女性）完成，16名PCP参加了焦点小组或个人访谈。BSH停用药物的主要障碍包括患者和PCP缺乏对BSH作用和副作用的了解，缺乏关于治疗睡眠问题和BSH处方的PCP教育，病人缺乏动力，五氯苯酚缺乏时间，对失眠症的认知行为治疗的机会有限，并且缺乏关于BSH的公开对话。促进者包括告知副作用，以激励患者停止BSH并在住院期间开始开处方。PCP的主要需求是针对睡眠问题的药理学和非药理学治疗以及开处方方案的实用建议。69％的PCP希望患者手册。PCP建议手册包含有关BSH风险和收益的解释，睡眠卫生和睡眠生理学，替代疗法,中止过程和逐渐减少的计划。
结论：我们确定的障碍和促进者以及对患者材料的PCP需求和意见，可用于开发PCP培训和BSH去处方材料，这可以帮助减少BSHs在睡眠问题上的不当使用。
