Use of Benzodiazepines by Older Primary Care Patients

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DESCRIPTION (provided by applicant): This R21 application is for an Exploratory/Developmental Project addressing the high prevalence of use of benzodiazepines by older primary care (PC) patients and their continued prescription by primary care providers (PCPs). This pattern of prescription and use persists despite clear evidence that these medications pose potentially significant health risks and despite the availability of medications and psychotherapies that are safer and more appropriate. There are already numerous randomized clinical trials evaluating strategies for facilitating discontinuation of benzodiazepines. However, there has been little dissemination of these strategies, and both the external and internal validity of these trials can be questioned because of low uptake, biased sampling, and selective retention of patients. Inappropriate use of benzodiazepines by the elderly is seen as a public health problem and prescriptions by PCP's is seen as a quality of care issue, yet we lack effective clinical tools to facilitate reduction in use. We propose a mixed method triangulation design to explicate older patients' and PCPs' perspectives on use of benzodiazepines. The first specific aim is to elicit PCPs' general implicit model of benzodiazepine prescription, including reactions to recommendations about their use. The second specific aim is to elicit patients' explanatory model, including their relevant experiences contributing to their use as well as their understanding of the locus of decision-making concerning their use. The third specific aim is to understand agreements and discrepancies between PCP and patient perspectives. The project involves a three phase sequential assessment: 1) qualitative interviews of 30 PCPs concerning general beliefs and attitudes about benzodiazepine prescription to older patients; 2) qualitative interviews and quantitative assessment of 5 patients drawn from each PCP concerning their symptomatic status and continued use of benzodiapezines; 3) follow-up assessment of PCP's concerning these specific patients and the PCPs response to our preliminary findings (member-checking). The key goal of this project is to understand the acceptability of both benzodiazepines usage by older patients and of strategies to reduce this use in order to design intervention studies yielding robustly acceptable and effective strategies for discontinuation.