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).

CONCLUSION

This consultant pharmacist educational intervention improved PCPs' confidence in deprescribing opioids and BZDs in older adults.