Use of Benzodiazepines by Older Primary Care Patients

描述（由申请人提供）：本R21申请用于探索性/开发性项目，旨在解决老年初级保健（PC）患者使用苯二氮卓类药物的高流行率以及初级保健提供者（PCP）继续为其开具处方的问题。尽管有明确的证据表明这些药物可能对健康构成重大风险，尽管有更安全和更适当的药物和心理治疗，但这种处方和使用模式仍然存在。已经有许多随机临床试验评估促进苯二氮卓类药物停药的策略。然而，这些策略的传播很少，这些试验的外部和内部有效性都受到质疑，因为低吸收，有偏见的采样和选择性保留的患者。老年人不适当使用苯二氮卓类药物被视为一个公共卫生问题，而PCP处方被视为一个护理质量问题，但我们缺乏有效的临床工具来促进减少使用。我们提出了一种混合方法三角设计，以解释老年患者和PCP的苯二氮卓类药物的使用的观点。第一个具体的目的是引出PCP的一般隐式模型的苯二氮卓类处方，包括反应的建议，他们的使用。第二个具体目标是引出患者的解释模型，包括他们的相关经验，有助于他们的使用，以及他们的理解的轨迹决策有关他们的使用。第三个具体目标是了解PCP和患者观点之间的一致性和差异。该项目包括三个阶段的连续评估：1）定性访谈30名PCP的一般信念和态度的苯二氮卓类处方的老年患者; 2）定性访谈和定量评估5名患者从每个PCP的症状状态和继续使用苯二氮卓类; 3）对这些特定患者的PCP进行后续评估，以及PCP对我们初步发现的反应（成员检查）。本项目的主要目标是了解老年患者使用苯二氮卓类药物的可接受性以及减少这种使用的策略，以设计干预研究，从而产生稳健可接受和有效的停药策略。

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.