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annfammed.org

PURPOSE Unlike in many community-based settings, benzodiazepine (BZD) prescribing to older veterans has decreased. We sought to identify health care system strategies associated with greater facility-level reductions in BZD prescribing to older adults. METHODS We completed an explanatory sequential mixed methods study of health care facilities in the Veterans Health Administration (N = 140). Among veterans aged ≥75 years receiving long-term BZD treatment, we stratified facilities into relatively high and low performance on the basis of the reduction in average daily dose of prescribed BZD from October 1, 2015 to June 30, 2017. We then interviewed key facility informants (n = 21) who led local BZD reduction efforts (champions), representing 11 high-performing and 6 low-performing facilities. RESULTS Across all facilities, the age-adjusted facility-level average daily dose in October 2015 began at 1.34 lorazepam-equivalent mg/d (SD 0.17); the average rate of decrease was −0.27 mg/d (SD 0.09) per year. All facilities interviewed, regardless of performance, used passive strategies primarily consisting of education regarding appropriate prescribing, alternatives, and identifying potential patients for discontinuation. In contrast, champions at high-performing facilities described leveraging ≥1 active strategies that included individualized recommendations, administrative barriers to prescribing, and performance measures to incentivize clinicians. CONCLUSIONS Initiatives to reduce BZD prescribing to older adults that are primarily limited to passive strategies, such as education and patient identification, might have limited success. Clinicians might benefit from additional recommendations, support, and incentives to modify prescribing practices.

diabetesjournals.org

American Diabetes Association

revespcardiol.org

Revista Española de Cardiología es una revista científica internacional dedicada a las enfermedades cardiovasculares. Editada desde 1947, encabeza REC Publications, la familia de revistas científicas de la Sociedad Española de Cardiología. La revista publica en español e inglés sobre todos los aspectos relacionados con las enfermedades cardiovasculares.

onlinelibrary.wiley.com

one of the largest and most authoritative collections of online journals, books, and research resources, covering life, health, social, and physical sciences.

sciencedirect.com

sciencedirect is the world's leading source for scientific, technical, and medical research. explore journals, books and articles.

pubmed.ncbi.nlm.nih.gov

Gates Foundation, St Jude Children's Research Hospital.