Training and Support Needed for Physicians in Deprescribing Benzodiazepine

Effectively enhancing benzodiazepine receptor agonists (BZRA) deprescription practices among older patients requires confronting physicians’ impulsive and reflective processes according to study findings published in JAMA Network Open.

In the current study, researchers sought to characterize the enables of and barriers to BZRA deprescription while also examining the institutional factors related to physician deprescription attitudes.

A 35-item questionnaire based upon the Theoretical Domains Framework (TDF) was used to identify barriers/enablers with responses categorized according to mean scores as major barriers, moderate barriers, and enablers. It was conducted between December 2022 and May 2023 and included hospital physicians and general practitioners (GPs) from Switzerland, Spain, Poland, Norway, Greece, and Belgium. Background characteristics and TDF-based domains associated with hospital physicians’ intention to deprescribe along with self-reported routine deprescribing were identified using multivariable logistic regressions.

Deprescribing was defined as the process of tapering and stopping drugs, aimed at improving patient outcomes and minimizing polypharmacy.

In the final sample, there were 240 hospital physicians and 96 GPs. The majority of participants were women (61.0% of hospital physicians; 54.2% of GPs). The majority of respondents reported deprescribing BZRA routinely (57.2% of hospital physicians; 72.5% of GPs).

Across the 6 countries, the researchers noted TDF domains and major barriers were similar among hospital physicians and GPs. Barriers included prioritization of other health issues (goals), frustration with the challenges of deprescribing (emotions), low self-efficacy (beliefs about capabilities), lack of training (skills), absence of local policies and insufficient staff and time, (environmental context and resources), and patient reluctance (social influence).

The investigators identified 2 enablers in 2 TDF domains for hospital physicians. Most physicians reported knowing the risks associated with BZRA use (knowledge) and believed benefits of deprescribing outweighed the risks (beliefs about consequences).

Routine deprescribing significantly associated with 3 TDF domains: intentions (odds ratio [OR], 4.42; 95% CI, 2.38-8.83); memory, attention, and decision processes (OR, 2.79; 95% CI, 1.73-4.69); and emotions (OR, 1.75; 95% CI, 1.04-3.04). Intention to deprescribe was significantly associated with occupation type, country, and 5 TDF domains: social and/or professional role and identity (OR, 5.92; 95% CI, 3.28-11.07); beliefs about consequences (OR, 3.00; 95% CI, 1.61-5.71); beliefs about capabilities (OR, 2.35; 95% CI, 1.55-3.63); memory, attention, and decision process (OR, 1.70; 95% CI, 1.22-2.40); and reinforcement (OR, 1.49; 95% CI, 1.05-2.15).

The researchers concluded, “[E]ffective deprescribing efforts require approaches that address both reflective processes (eg, enhancing capability) and impulsive processes (eg, managing emotions).”

Study limitations include questionnaires not fully capturing participants’ perspectives, target sample size of 120 GPs not reached, social desirability bias among participating physicians, and the use of arbitrary cut-offs to categorize results into enablers, or moderate or major barriers.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Psychiatry Advisor