Evaluation of a benzodiazepine deprescribing quality improvement initiative for older adults in primary care

Abstract

AbstractBackgroundOlder adults are commonly prescribed long‐term benzodiazepines for anxiety and insomnia despite evidence of risks and limited evidence of long‐term benefits. Recent quality measures and guidelines have recommended benzodiazepine deprescribing, yet there is little real‐world data on clinic‐based deprescribing programs.MethodsWe developed a benzodiazepine deprescribing quality improvement program for older adults at a large US academic medical center. The program targeted adults aged 65 years and older who were prescribed chronic benzodiazepines by their primary care physician (PCP). PCPs were contacted to opt‐out patients not suitable for deprescribing; then eligible patients were mailed a letter discussing patient‐specific risks and advising them to discuss deprescribing with their PCP or a pharmacist who was available to support tapering. The primary outcomes were the number of patients who discussed deprescribing and who initiated a taper within 90 days of outreach.ResultsOf 504 older adults prescribed benzodiazepines, 133 (26%) were opted out by their PCPs leaving a cohort of 371 (median age 71 years [IQR 68–75], 58% female, 82% White). The median daily diazepam milligram equivalent was 5 mg (IQR 3–6 mg) and 30% were prescribed long‐acting benzodiazepines. Three months following patient outreach, 97 patients (26%) had a documented discussion of benzodiazepines with their PCP or clinic pharmacist. Of these patients, 35 (36%) had documentation of a deprescribing discussion and 25 (26%) initiated a taper. At 12 months, 16 patients (64%) were tapered successfully, with nine (36%) patients taking a lower benzodiazepine dose and seven (28%) discontinuing benzodiazepines completely.ConclusionsA low‐intensity benzodiazepine deprescribing outreach program led to deprescribing conversations for a minority of patients, but one‐quarter of older adults who engaged in a conversation chose to taper and nearly two‐thirds sustained reduced use. Incorporating benzodiazepine deprescribing into routine care may require more intensive population‐health efforts to engage patients and clinicians.