Mapping care trajectories for hospital-initiated benzodiazepine deprescribing in older adults

Background: Long-term prescription of benzodiazepine receptor agonists (BZRAs) for insomnia in adults over 65 years of age is considered a low-value care practice. Although deprescribing has emerged as a possible solution, the implementation of BZRA deprescribing has been considered insufficient in...

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Autores: Dikeos, Dimitris, Miralles Basseda, Ramon|||0000-0002-7770-7819, Grimshaw, Jeremy, López-Toribio, María, Dalleur, Olivia, Adda, Tokandji Rostand, de Saint Hubert, Marie, Tsoutsi, Vagioula, Callegari, Enrico, Wyller, Torgeir Bruun, Wichniak, Adam, Kaznowski, Martha, Pascual, Begoña, Fernández Maldonado, Laura|||0000-0002-2978-0528, Aubert, Carole Elodie, Mooser, Blandine, Bolt, Lucy, Spinewine, Anne, Macq, Jean
Tipo de recurso: artículo
Fecha de publicación:2025
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:dnet:uabarcelona_::14a99504f147b2f5ba44ef3cadce4aee
Acceso en línea:https://ddd.uab.cat/record/327588
https://dx.doi.org/urn:doi:10.1186/s12913-025-13725-2
Access Level:acceso abierto
Palabra clave:Benzodiazepines
Care trajectory
Delivery of healthcare
Deprescribing
Elderly
Quality of health care
Shared decision making
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spelling Mapping care trajectories for hospital-initiated benzodiazepine deprescribing in older adultsa multicentre qualitative studyDikeos, DimitrisMiralles Basseda, Ramon|||0000-0002-7770-7819Grimshaw, JeremyLópez-Toribio, MaríaDalleur, OliviaAdda, Tokandji Rostandde Saint Hubert, MarieTsoutsi, VagioulaCallegari, EnricoWyller, Torgeir BruunWichniak, AdamKaznowski, MarthaPascual, BegoñaFernández Maldonado, Laura|||0000-0002-2978-0528Aubert, Carole ElodieMooser, BlandineBolt, LucySpinewine, AnneMacq, JeanBenzodiazepinesCare trajectoryDelivery of healthcareDeprescribingElderlyQuality of health careShared decision makingBackground: Long-term prescription of benzodiazepine receptor agonists (BZRAs) for insomnia in adults over 65 years of age is considered a low-value care practice. Although deprescribing has emerged as a possible solution, the implementation of BZRA deprescribing has been considered insufficient in routine clinical care. Mapping care trajectories relative to BZRA deprescribing can help identify inefficiencies in current care and propose strategies to enhance the implementation of deprescribing interventions in the long term. This study aims to map care trajectories and characterise contextual factors relevant to hospital-initiated BZRA deprescribing in older adults. Methods: A qualitative study was conducted with local researchers, healthcare professionals (HCPs), patients, and informal carers in six European countries (Belgium, Greece, Norway, Poland, Spain, and Switzerland). Three theoretical frameworks were used to guide data collection and analyses: 1) the '6W' multidimensional model of care trajectories; 2) the patient-centred deprescribing process; and 3) the Context and Capabilities for Integrating Care framework. Data was collected online through self-administered questionnaires, individual interviews, and group validation interviews. Data were transcribed verbatim and analysed using a combination of deductive and inductive thematic analyses. Results: We collected 18 responses to surveys, and conducted 53 interviews (6 local researchers, 36 HCPs, 11 patients or informal carers) and 7 group interviews (comprising 28 HCPs, 4 patients). We developed nine validated care trajectory maps by hospital department and type of unit, and two general comparative maps for inpatient and outpatient care. Hospital-initiated BZRA deprescribing emerged as a complex healthcare process that is likely to involve several HCPs from hospital and primary care. Participants considered patient involvement in shared decision-making (SDM) to be crucial in deprescribing, but implementation was scarce in routine care. The type of HCPs involved and the communication channels between them were specific to each country. Fragmented care and poor communication in the care trajectory hindered follow-up and continuity of care. Conclusions: Deprescribing interventions should include context-sensitive strategies to promote patient participation in SDM, foster the use of guidelines, and enhance interprofessional collaboration along the care trajectory. Care trajectory maps can be used as an implementation tool to translate BZRA deprescribing interventions into routine practice. 22025-01-0120252025-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/327588https://dx.doi.org/urn:doi:10.1186/s12913-025-13725-2reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.https://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:dnet:uabarcelona_::14a99504f147b2f5ba44ef3cadce4aee2026-06-06T12:50:31Z
dc.title.none.fl_str_mv Mapping care trajectories for hospital-initiated benzodiazepine deprescribing in older adults
a multicentre qualitative study
title Mapping care trajectories for hospital-initiated benzodiazepine deprescribing in older adults
spellingShingle Mapping care trajectories for hospital-initiated benzodiazepine deprescribing in older adults
Dikeos, Dimitris
Benzodiazepines
Care trajectory
Delivery of healthcare
Deprescribing
Elderly
Quality of health care
Shared decision making
title_short Mapping care trajectories for hospital-initiated benzodiazepine deprescribing in older adults
title_full Mapping care trajectories for hospital-initiated benzodiazepine deprescribing in older adults
title_fullStr Mapping care trajectories for hospital-initiated benzodiazepine deprescribing in older adults
title_full_unstemmed Mapping care trajectories for hospital-initiated benzodiazepine deprescribing in older adults
title_sort Mapping care trajectories for hospital-initiated benzodiazepine deprescribing in older adults
dc.creator.none.fl_str_mv Dikeos, Dimitris
Miralles Basseda, Ramon|||0000-0002-7770-7819
Grimshaw, Jeremy
López-Toribio, María
Dalleur, Olivia
Adda, Tokandji Rostand
de Saint Hubert, Marie
Tsoutsi, Vagioula
Callegari, Enrico
Wyller, Torgeir Bruun
Wichniak, Adam
Kaznowski, Martha
Pascual, Begoña
Fernández Maldonado, Laura|||0000-0002-2978-0528
Aubert, Carole Elodie
Mooser, Blandine
Bolt, Lucy
Spinewine, Anne
Macq, Jean
author Dikeos, Dimitris
author_facet Dikeos, Dimitris
Miralles Basseda, Ramon|||0000-0002-7770-7819
Grimshaw, Jeremy
López-Toribio, María
Dalleur, Olivia
Adda, Tokandji Rostand
de Saint Hubert, Marie
Tsoutsi, Vagioula
Callegari, Enrico
Wyller, Torgeir Bruun
Wichniak, Adam
Kaznowski, Martha
Pascual, Begoña
Fernández Maldonado, Laura|||0000-0002-2978-0528
Aubert, Carole Elodie
Mooser, Blandine
Bolt, Lucy
Spinewine, Anne
Macq, Jean
author_role author
author2 Miralles Basseda, Ramon|||0000-0002-7770-7819
Grimshaw, Jeremy
López-Toribio, María
Dalleur, Olivia
Adda, Tokandji Rostand
de Saint Hubert, Marie
Tsoutsi, Vagioula
Callegari, Enrico
Wyller, Torgeir Bruun
Wichniak, Adam
Kaznowski, Martha
Pascual, Begoña
Fernández Maldonado, Laura|||0000-0002-2978-0528
Aubert, Carole Elodie
Mooser, Blandine
Bolt, Lucy
Spinewine, Anne
Macq, Jean
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Benzodiazepines
Care trajectory
Delivery of healthcare
Deprescribing
Elderly
Quality of health care
Shared decision making
topic Benzodiazepines
Care trajectory
Delivery of healthcare
Deprescribing
Elderly
Quality of health care
Shared decision making
description Background: Long-term prescription of benzodiazepine receptor agonists (BZRAs) for insomnia in adults over 65 years of age is considered a low-value care practice. Although deprescribing has emerged as a possible solution, the implementation of BZRA deprescribing has been considered insufficient in routine clinical care. Mapping care trajectories relative to BZRA deprescribing can help identify inefficiencies in current care and propose strategies to enhance the implementation of deprescribing interventions in the long term. This study aims to map care trajectories and characterise contextual factors relevant to hospital-initiated BZRA deprescribing in older adults. Methods: A qualitative study was conducted with local researchers, healthcare professionals (HCPs), patients, and informal carers in six European countries (Belgium, Greece, Norway, Poland, Spain, and Switzerland). Three theoretical frameworks were used to guide data collection and analyses: 1) the '6W' multidimensional model of care trajectories; 2) the patient-centred deprescribing process; and 3) the Context and Capabilities for Integrating Care framework. Data was collected online through self-administered questionnaires, individual interviews, and group validation interviews. Data were transcribed verbatim and analysed using a combination of deductive and inductive thematic analyses. Results: We collected 18 responses to surveys, and conducted 53 interviews (6 local researchers, 36 HCPs, 11 patients or informal carers) and 7 group interviews (comprising 28 HCPs, 4 patients). We developed nine validated care trajectory maps by hospital department and type of unit, and two general comparative maps for inpatient and outpatient care. Hospital-initiated BZRA deprescribing emerged as a complex healthcare process that is likely to involve several HCPs from hospital and primary care. Participants considered patient involvement in shared decision-making (SDM) to be crucial in deprescribing, but implementation was scarce in routine care. The type of HCPs involved and the communication channels between them were specific to each country. Fragmented care and poor communication in the care trajectory hindered follow-up and continuity of care. Conclusions: Deprescribing interventions should include context-sensitive strategies to promote patient participation in SDM, foster the use of guidelines, and enhance interprofessional collaboration along the care trajectory. Care trajectory maps can be used as an implementation tool to translate BZRA deprescribing interventions into routine practice.
publishDate 2025
dc.date.none.fl_str_mv 2
2025-01-01
2025
2025-01-01
dc.type.none.fl_str_mv Article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://ddd.uab.cat/record/327588
https://dx.doi.org/urn:doi:10.1186/s12913-025-13725-2
url https://ddd.uab.cat/record/327588
https://dx.doi.org/urn:doi:10.1186/s12913-025-13725-2
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Dipòsit Digital de Documents de la UAB
instname:Universitat Autònoma de Barcelona
instname_str Universitat Autònoma de Barcelona
reponame_str Dipòsit Digital de Documents de la UAB
collection Dipòsit Digital de Documents de la UAB
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