3 results
148 Sustainability of a Benzodiazepine Deprescribing Intervention with Primary Care Providers in a University-Based Community Clinic
- Lois M. Platt, Teresa A. Savage
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- Journal:
- CNS Spectrums / Volume 25 / Issue 2 / April 2020
- Published online by Cambridge University Press:
- 24 April 2020, pp. 294-295
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Study Objectives:
In light of the opioid crisis, less attention has been focused on the long-term misuse of benzodiazepines (BZD) for anxiety and sleep disorders. The purpose of this study was to determine the sustainability of positive results (an 80% decrease in BZD prescribing) following a deprescribing intervention with primary care providers working with a low-income population at a Midwestern university-based community clinic.
Method:All de-identified BZD prescriptions written by providers at the community clinic were captured using the electronic medical record. A BZD equivalency chart was used to compare the relative potencies of BZD commonly prescribed by the clinic. Each prescription was converted to a single number: the diazepam equivalent (DE). This number takes into account the potency of the drug (using diazepam as the standard), the dose of the drug, number of tablets dispensed and number of refills. The number of DE prescribed was tallied every 30 days for 6 months following the completion of a quality improvement BZD deprescribing intervention. The original intervention was implemented in 2018, with the goal of decreasing the prescription of BZD by clinic primary care providers to outpatients for insomnia or anxiety. The brief intervention combined academic detailing and pharmaceutical company detailing with a deprescribing message. Providers were given current evidence about alternatives to BZD, deprescribing schedules, and brain-storming opportunities about the management of patient concerns and resistance to change. Posters with alternatives to BZD were hung in the main provider office at the clinic. Food and “No Benzo” logo merchandise (mugs, pens) were provided to attendees of the intervention and clinic nurses. Thirty days after the intervention, the number of DE prescribed decreased by 80%.
Results:Benzodiazepine prescribing (measured in DE) continued to decrease every 30 days for six months to 92-93% of pre-intervention numbers.
Conclusions:Follow up of a 2018 intervention revealed sustainability of the effect of a significant decrease in benzodiazepine (BZD) prescribing in a community clinic. A brief BZD deprescribing intervention using a combination of academic detailing and pharmaceutical company detailing designed to persuade prescribers to change their behavior was effective in influencing providers to decrease the amount of BZD they prescribe. The desired result (an 80% decrease in BZD prescribing) was achieved following the original 30-day intervention. Prescription numbers continued to decrease over the next six months (to 92-93% of pre-intervention numbers), which indicates that the deprescribing intervention may have had a sustainable positive effect on provider prescribing behavior. This intervention is easy to implement and may decrease BZD prescribing, which addresses the overuse/misuse of BZD, a significant public health concern in the United States.
Funding Acknowledgements: Personal funds only
33 An Intervention to Decrease Benzodiazepine Prescribing by Providers in an Urban Clinic
- Lois Platt, Teresa A. Savage, Nimmi Rajagopal
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- Journal:
- CNS Spectrums / Volume 24 / Issue 1 / February 2019
- Published online by Cambridge University Press:
- 12 March 2019, pp. 192-193
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STUDY OBJECTIVES
Outpatient benzodiazepine use can cause side effects including dependence (20–30%) and death from respiratory depression when used with alcohol or opioids. Benzodiazepine use is on the rise in the U.S., increasing 67% from 1996–2013. In this quality improvement project, two educational interventions were combined with the intent of decreasing benzodiazepine prescribing by providers (MDs, APRNs) in an urban university clinic.
STUDY QUESTIONWhen prescribers working in a low-income clinic receive an intervention to increase awareness of benzodiazepine dangers and promote harm reduction strategies compared to treatment as usual, do they write fewer benzodiazepine prescriptions in the month following the intervention?
METHODA hybrid intervention combining academic detailing (educational outreach visits) and pharmaceutical industry detailing (merchandising, relationship building) was provided in two sessions to family practice providers (salaried and residents) working in a university outpatient clinic in Chicago. The subject matter included benzodiazepine risks, alternative treatments for anxiety & insomnia, and methods to deal with patient demand. All clinic providers (n=40) were invited to participate. Participants were self-selected to attend each session (although resident physicians were obligated to attend). A total of 20–24 providers attended each session.
Benzodiazepine prescription information was extracted by clinic information systems for two periods: 12months pre-intervention, and 30days post-intervention. For ease of comparison, each prescription was converted to a common denominator: the diazepam-equivalent dose. The pre-intervention monthly average (for one year) was compared to 30-day post-intervention data. The outcome measure was the numeric difference in the prescribed diazepam-equivalents pre- and post-intervention. This number was used as a measure of the effectiveness of the intervention. A decrease in prescribing post- compared to pre-intervention would indicate a successful intervention.
RESULTSThere was an 80% decrease in benzodiazepine prescribing in the 30-day post-intervention period compared to the 12-month pre-intervention monthly average. This result cannot be explained by personnel changes at the clinic. Although these did occur in 2017, the pattern of prescribing was stable throughout the year prior to this intervention.
CONCLUSIONSThe combination of academic and pharmaceutical industry detailing influenced family practice providers in an urban clinic setting to decrease benzodiazepine prescribing by 80%. Decreased benzodiazepine prescribing should decrease patient morbidity and mortality.
Perinatal palliative care: Parent perceptions of caring in interactions surrounding counseling for risk of delivering an extremely premature infant
- Karen Kavanaugh, Cecelia I. Roscigno, Kristen M. Swanson, Teresa A. Savage, Robert E. Kimura, Sarah J. Kilpatrick
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- Journal:
- Palliative & Supportive Care / Volume 13 / Issue 2 / April 2015
- Published online by Cambridge University Press:
- 04 November 2013, pp. 145-155
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Objective:
When infants are at risk of being born at a very premature gestation (22–25 weeks), parents face important life-support decisions because of the high mortality for such infants. Concurrently, providers are challenged with providing parents a supportive environment within which to make these decisions. Practice guidelines for medical care of these infants and the principles of perinatal palliative care for families can be resources for providers, but there is limited research to bridge these medical and humanistic approaches to infant and family care. The purpose of this article is to describe how parents at risk of delivering their infant prior to 26 weeks gestation interpreted the quality of their interpersonal interactions with healthcare providers.
Methods:Directed content analysis was employed to perform secondary analysis of data from 54 parents (40 mothers and 14 fathers) from the previously coded theme “Quality of Interactions.” These categorized data described parents' encounters, expectations, and experiences of interactions that occurred prenatally with care providers. For this analysis, Swanson's theory of caring was selected to guide analysis and to delineate parents' descriptions of caring and uncaring interactions.
Results:Parents' expectations for caring included: (a) respecting parents and believing in their capacity to make the best decisions for their family (maintaining belief); (b) understanding parents' experiences and their continued need to protect their infant (knowing); (c) physically and emotionally engaging with the parents (being with); (d) providing unbiased information describing all possibilities (enabling); and (e) helping parents navigate the system and creating a therapeutic environment for them in which to make decisions (doing for).
Significance of Results:Understanding parents' prenatal caring expectations through Swanson's theory gives deeper insights, aligning their expectations with the palliative care movement.