Equipping physicians for benzodiazepine receptor agonists deprescription in older adults: theory-based development of the BE-SAFE intervention

François-Xavier Sibille; Joanna Salbert; Lucy Bolt; Vagioula Tsoutsi; Enrico Callegari; Olivia Dalleur; Tokandji Adda; Thomas Agoritsas; Thomas Berger; Carole E Aubert; Dimitris Dikeos; Antoni Salvà; Begoña Pascual; Ramon Miralles; Torgeir Bruun Wyller; Andrea M Patey; Jeremy M Grimshaw; Adam Wichniak; Anne Spinewine; Marie de Saint Hubert

doi:10.1016/j.sapharm.2025.05.002

Equipping physicians for benzodiazepine receptor agonists deprescription in older adults: theory-based development of the BE-SAFE intervention

Res Social Adm Pharm. 2025 Sep;21(9):714-721. doi: 10.1016/j.sapharm.2025.05.002. Epub 2025 May 21.

Authors

François-Xavier Sibille¹, Joanna Salbert², Lucy Bolt³, Vagioula Tsoutsi⁴, Enrico Callegari⁵, Olivia Dalleur⁶, Tokandji Adda⁷, Thomas Agoritsas⁸, Thomas Berger⁹, Carole E Aubert³, Dimitris Dikeos⁴, Antoni Salvà¹⁰, Begoña Pascual¹¹, Ramon Miralles¹², Torgeir Bruun Wyller¹³, Andrea M Patey¹⁴, Jeremy M Grimshaw¹⁵, Adam Wichniak², Anne Spinewine¹⁶, Marie de Saint Hubert¹⁷

Affiliations

¹ Clinical Pharmacy and Pharmacoepidemiology Research Group, Louvain Drug Research Institute, UCLouvain Belgium; Geriatric Department, CHU UCL Namur, Yvoir, Belgium; Institute of Health and Society, UCLouvain, Belgium. Electronic address: francois-xavier.sibille@chuuclnamur.uclouvain.be.
² Third Department of Psychiatry and Sleep Medicine Center, Institute of Psychiatry and Neurology, Warsaw, Poland.
³ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Switzerland.
⁴ Sleep Research Unit, First Department of Psychiatry, Eginition Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece.
⁵ Department of Old Age Psychiatry, Østfold Hospital Trust, Grålum, Norway; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
⁶ Clinical Pharmacy and Pharmacoepidemiology Research Group, Louvain Drug Research Institute, UCLouvain Belgium; Pharmacy Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
⁷ Clinical Pharmacy and Pharmacoepidemiology Research Group, Louvain Drug Research Institute, UCLouvain Belgium.
⁸ Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, University of Geneva, Switzerland; Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada; MAGIC Evidence Ecosystem Foundation, Oslo, Norway.
⁹ Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Switzerland.
¹⁰ Fundació Salut i Envelliment - Universidad Autonoma de Barcelona, Spain.
¹¹ Badalona Serveis Assistencials, Badalona, Spain.
¹² Hospital Germans Tries i Pujol, Badalona (Barcelona), Spain.
¹³ Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
¹⁴ Methodology and Implementation Research, Ottawa Hospital Research Institute, Canada.
¹⁵ Methodology and Implementation Research, Ottawa Hospital Research Institute, Canada; Department of Medicine, University of Ottawa, Canada.
¹⁶ Clinical Pharmacy and Pharmacoepidemiology Research Group, Louvain Drug Research Institute, UCLouvain Belgium; Pharmacy Department, CHU UCL Namur, Yvoir, Belgium.
¹⁷ Geriatric Department, CHU UCL Namur, Yvoir, Belgium; Institute of Health and Society, UCLouvain, Belgium.

PMID: 40450448
DOI: 10.1016/j.sapharm.2025.05.002

Abstract

Background: Benzodiazepine receptor agonists (BZRA) are still widely used for sleep problems in older adults despite an unfavourable risk-benefit ratio. The hospital setting presents an opportunity for optimising medication use in older adults. The BE-SAFE project follows a rigorous sequential approach for developing a theory-informed intervention towards BZRA deprescription initiated in the hospital setting in 6 European countries (Belgium, Greece, Norway, Poland, Spain, and Switzerland).

Objectives: The objectives of this paper are to describe the development of the physicians' intervention, the results of on the acceptability and perceived feasibility with physicians, and the finalised BE-SAFE intervention.

Methods: The intervention was built upon preliminary work and developed in four main steps: selection of behaviour change techniques; identification of existing resources and assessment of needs and preferences of hospital physicians; development of intervention components and modes of delivery; and end-users' evaluation and refinement of intervention.

Results: A total of 11 behaviour change techniques were selected, addressing 6 main barriers into a 6-component intervention: senior physician endorsement, training, self-monitoring, deprescription algorithm, communication to patients and other healthcare professionals. These core elements will be delivered allowing local adaptability. Twenty-four physicians evaluated the intervention. They confirmed that the intervention effectively targets the barriers highlighted in preliminary work and provided feedback for improvement regarding clarity and time issues.

Conclusions: A 6-component physician's intervention to enhance BZRA deprescription initiated in hospital settings was developed by systematically addressing implementation issues in a theory informed manner. This intervention will be evaluated in a multi-country cluster randomised controlled trial.

Keywords: Benzodiazepine receptor agonists; Deprescription; Hospital physicians; Intervention development; Older adults.

MeSH terms

Aged
Deprescriptions*
Europe
GABA-A Receptor Agonists* / administration & dosage
GABA-A Receptor Agonists* / adverse effects
GABA-A Receptor Agonists* / therapeutic use
Humans
Male
Physicians*
Sleep Wake Disorders / drug therapy

Substances

GABA-A Receptor Agonists