建立初级保健提供者对老年人处方阿片类药物和苯二氮卓类药物的信心

IF 1.8 Q3 PHARMACOLOGY & PHARMACY

Exploratory research in clinical and social pharmacy Pub Date : 2025-06-24 DOI:10.1016/j.rcsop.2025.100627

Stefanie P. Ferreri , Lori T. Armistead , Ben Urick , Tamera D. Hughes , Anne-Therese Hunt , J. Marvin McBride , Joshua Niznik , Ellen Roberts , Kimberly A. Sanders , Jan Busby-Whitehead

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引用次数: 0

摘要

阿片类药物和苯二氮卓类药物（BZDs）是导致老年人跌倒的最常用药物之一；然而，关于它们的安全处方和解除处方的指导很少。虽然有一些资源可以帮助阿片类药物和BZD处方的提供者，但许多人报告缺乏信心是一个障碍。本研究的目的是评估pcp在干预前后解除阿片类药物和BZDs处方能力的信心。方法我们修改了一项经过验证的处方自我效能感调查，以评估初级保健提供者（PCP）在咨询药师教育干预前后对老年人阿片类药物和bzd处方的信心。调查包括35个问题，分为三个部分：处方阿片类药物（10个问题），处方bzd（10个问题），以及在潜在阻碍情况下处方[UPIC]（15个问题）。使用改进的Dillman方法将调查结果发送给88个pcp。我们在干预前和干预后以100分制评估了提供者的信心，比较了干预组和对照组之间的得分差异（DID）。结果干预前和干预后共有41名pcp（46.6%）完成了调查。干预组（n = 21）在知识和自我效能技能方面平均提高了19.7分（满分100分），而对照组（n = 20）平均提高了5.2分。两组患者自我效能改善DID总分为+14.5分（p = 0.003）。对于阿片类药物、BZD和upic特异性评分，干预组的DID与对照组相比具有统计学意义(+15.8,p = 0.004；+14.2, p = 0.017；+13.9, p = 0.016)。结论咨询药师教育干预提高了pcp对老年人阿片类药物处方和BZDs的信心。

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Building primary care providers' confidence in deprescribing opioids and benzodiazepines in older adults

Background

Opioids and benzodiazepines (BZDs) are among the most prescribed medications that contribute to falls in older adults; however, little guidance exists on their safe prescribing and deprescribing. Although some resources are available to assist providers with opioid and BZD deprescribing, many report lack of confidence as a barrier. The objective of this study was to assess PCPs' confidence in their ability to deprescribe opioids and BZDs before and after an intervention.

Methods

We modified a validated deprescribing self-efficacy survey to assess primary care provider (PCP) confidence in deprescribing opioids and BZDs in older adults before and after a consultant pharmacist educational intervention. The survey consisted of 35 questions divided into three sections: deprescribing opioids (10 questions), deprescribing BZDs (10 questions), and deprescribing under potentially impeding circumstances [UPIC] (15 questions). The survey was sent to 88 PCPs using a modified Dillman method. We evaluated providers' confidence on a 100-point scale pre- and post-intervention, comparing the difference-in- differences (DID) in scores between the intervention and control groups.

Results

A total of 41 PCPs (46.6 %) completed the survey both pre-and post-intervention. The intervention group (n = 21) showed an improvement in their knowledge and self-efficacy skills by an average of 19.7 out of 100 points, while the control group (n = 20) improved by an average of 5.2 points. The DID in self-efficacy improvement between the two groups was +14.5 points (p = 0.003) overall. For each of the opioid-, BZD-, and UPIC-specific scores, the intervention group had a statistically significant DID compared to the control group (+15.8, p = 0.004; +14.2, p = 0.017; +13.9, p = 0.016, respectively).