TY - JOUR
KW - Analgesics, Opioid/adverse effects
KW - Benzodiazepines/adverse effects
KW - Humans
KW - Mental Health
KW - Pharmacists
KW - Primary Health Care
KW - Specialization
KW - United States
KW - Benzodiazepines
KW - deprescribing
KW - determinants
KW - Opioids
KW - primary care
AU - E. J. Hawkins
AU - A. M. Lott
AU - A. N. Danner
AU - C. A. Malte
AU - H. J. Hagedorn
AU - D. Berger
AU - L. M. Donovan
AU - G. G. Sayre
AU - A. J. Mariano
AU - A. J. Saxon
A1 - 
AB - OBJECTIVE: Due to increased risks of overdose fatalities and injuries associated with coprescription of opioids and benzodiazepines, healthcare systems have prioritized deprescribing this combination. Although prior work has examined providers' perspectives on deprescribing each medication separately, perspectives on deprescribing patients with combined use is unclear. We examined providers' perspectives on coprescribed opioids and benzodiazepines and identified barriers and facilitators to deprescribing. DESIGN: Qualitative study using semistructured interviews. SETTING: One multisite Veterans Affairs (VA) healthcare system in the United States of America. SUBJECTS: Primary care and mental health prescribers, key clinical leaders, clinical pharmacist specialists (N = 39). METHODS: Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. Themes were identified iteratively, through a multidisciplinary team-based process. RESULTS: Analyses identified four themes related to barriers and facilitators to deprescribing: inertia, prescriber self-efficacy, feasibility of deprescribing/tapering, and promoting deprescribing, as well as a fifth theme, consequences of deprescribing. Results highlighted the complexity of deprescribing when multiple prescribers are involved, a need for additional support and time, and concerns about patients' reluctance to discontinue these medications. Facilitators included agreement with the goal of deprescribing and fear of negative consequences if medications are continued. Providers spoke to how deprescribing efforts impaired patient-provider relationships and informed their decisions not to start patients on these medications. CONCLUSIONS: Although providers agree with the goal, prescribers' belief in a limited deprescribing role, challenges with coordination among prescribers, concerns about insufficient time and patients' resistance to discontinuing these medications need to be addressed for efforts to be successful.
AD - Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington, USA.; Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington, USA.; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA.; Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington, USA.; Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington, USA.; Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington, USA.; Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington, USA.; Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington, USA.; Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington, USA.; Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA.; Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.; General Medicine Service, VA Puget Sound Health Care System, Seattle, Washington, USA.; Department of Medicine, University of Washington, Seattle, Washington, USA.; Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle,(TRUNCATED)
BT - Pain medicine (Malden, Mass.)
C5 - Education & Workforce; Opioids & Substance Use
CP - 7
DO - 10.1093/pm/pnaa435
IS - 7
JF - Pain medicine (Malden, Mass.)
LA - eng
M1 - Journal Article
N2 - OBJECTIVE: Due to increased risks of overdose fatalities and injuries associated with coprescription of opioids and benzodiazepines, healthcare systems have prioritized deprescribing this combination. Although prior work has examined providers' perspectives on deprescribing each medication separately, perspectives on deprescribing patients with combined use is unclear. We examined providers' perspectives on coprescribed opioids and benzodiazepines and identified barriers and facilitators to deprescribing. DESIGN: Qualitative study using semistructured interviews. SETTING: One multisite Veterans Affairs (VA) healthcare system in the United States of America. SUBJECTS: Primary care and mental health prescribers, key clinical leaders, clinical pharmacist specialists (N = 39). METHODS: Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. Themes were identified iteratively, through a multidisciplinary team-based process. RESULTS: Analyses identified four themes related to barriers and facilitators to deprescribing: inertia, prescriber self-efficacy, feasibility of deprescribing/tapering, and promoting deprescribing, as well as a fifth theme, consequences of deprescribing. Results highlighted the complexity of deprescribing when multiple prescribers are involved, a need for additional support and time, and concerns about patients' reluctance to discontinue these medications. Facilitators included agreement with the goal of deprescribing and fear of negative consequences if medications are continued. Providers spoke to how deprescribing efforts impaired patient-provider relationships and informed their decisions not to start patients on these medications. CONCLUSIONS: Although providers agree with the goal, prescribers' belief in a limited deprescribing role, challenges with coordination among prescribers, concerns about insufficient time and patients' resistance to discontinuing these medications need to be addressed for efforts to be successful.
PY - 2021
SN - 1526-4637; 1526-2375
SP - 1559
EP - 1569
EP - 
T1 - Primary Care and Mental Health Prescribers, Key Clinical Leaders, and Clinical Pharmacist Specialists' Perspectives on Opioids and Benzodiazepines
T2 - Pain medicine (Malden, Mass.)
TI - Primary Care and Mental Health Prescribers, Key Clinical Leaders, and Clinical Pharmacist Specialists' Perspectives on Opioids and Benzodiazepines
U1 - Education & Workforce; Opioids & Substance Use
U2 - 33661287
U3 - 10.1093/pm/pnaa435
VL - 22
VO - 1526-4637; 1526-2375
Y1 - 2021
Y2 - Jul 25
ER -