■尽管建议在老年人中停用慢性苯二氮卓受体激动剂(BZRA),在比利时疗养院(NHs)中使用它们的患病率保持在50%以上。使用行为科学方法,从评估BZRA开药的障碍和推动者开始,有可能减少BZRA处方。
■确定比利时参与养老院护理的不同利益相关者所认为的BZRA开药的障碍和促成因素。
■在6个NHs的目的性样本中,我们与全科医生(GP)进行了面对面的访谈,以及与其他医疗保健提供者(HCP)的焦点小组,包括护士,药剂师,职业治疗师,物理治疗师,以及NH居民和亲戚。所有对HCP的访谈都是通过演绎主题分析进行分析的,使用理论域框架(TDF)作为编码框架。使用归纳主题方法对居民和亲戚的访谈进行了分析。
■我们采访了13位GP,35个其他HCP,22位养老院居民,5亲戚总的来说,9个TDF域被确定为在接受采访的HCP中最相关的:技能,关于能力的信念,目标,记忆注意力和决策过程,环境背景和资源,社会影响,知识,社会/职业角色和身份,以及对后果的信念。居民和亲戚访谈中出现了另外五个主题:有关使用药物的知识,与NH员工和全科医生的沟通,BZRA的感知功效和必要性,环境的影响,也不愿BZRA开药。利益相关者之间的某些领域和主题有所不同(例如,知识),而其他人在组之间匹配(例如,环境方面)。
■BZRA开药受知识和技能差距的影响,自动BZRA再填充,相互竞争的优先事项,社会挑战,环境因素和养老院居民参与不良。针对这些障碍将是实施BZRA取消处方的关键步骤。
UNASSIGNED: Despite recommendations to deprescribe chronic benzodiazepine receptor agonists (BZRA) among older adults, the prevalence of their use in Belgian nursing homes (NHs) remains above 50%. The use of a behavioral science approach, starting with the evaluation of barriers and enablers for BZRA deprescribing, has the potential to decrease BZRA prescribing.
UNASSIGNED: To identify barriers and enablers for BZRA deprescribing perceived by the different stakeholders involved in nursing home care in Belgium.
UNASSIGNED: In a purposive sample of 6 NHs, we conducted face-to-face interviews with general practitioners (GPs), and focus groups with other healthcare providers (HCPs), including nurses, pharmacists, occupational therapists, physical therapists, and with NH residents and relatives. All interviews with HCPs were analyzed through deductive thematic analysis, using the theoretical domains framework (TDF) as the coding framework. Residents\' and relatives\' interviews were analyzed using an inductive thematic approach.
UNASSIGNED: We interviewed 13 GPs, 35 other HCPs, 22 nursing home residents, and 5 relatives. Overall, 9 TDF domains were identified as most relevant among HCPs interviewed: Skills, Beliefs about capabilities, Goals, Memory attention and decision processes, Environmental context and resources, Social influences, Knowledge, Social/professional role and identity, and Beliefs about consequences. Five additional themes emerged from residents\' and relatives\' interviews: knowledge on medications used, communication with NH staff and GPs, perceived efficacy and necessity of BZRA, influence of the environment, and reluctance towards BZRA deprescribing. Some domains and themes differ between stakeholders (e.g., knowledge), while others match between groups (e.g., environmental aspects).
UNASSIGNED: BZRA deprescribing is influenced by knowledge and skills gaps, automatic BZRA refilling, competing priorities, social challenges, environmental factors and poor nursing home residents involvement. Targeting these barriers will be a key step for implementation of BZRA deprescribing.