Barriers to and Enablers of Supporting Deprescribing Benzodiazepines in Older Adults: A Survey of European Nonphysician Healthcare Professionals

Abstract

Although physicians are primarily responsible for Benzodiazepine Receptor Agonist (BZRA) deprescribing, nonphysician healthcare professionals (HCPs) can support deprescribing. This study explored barriers to and enablers of BZRA deprescribing among nonphysician HCPs. We surveyed 258 HCPs (63.2% nurses) working in hospital settings across six European countries using a questionnaire based on the Theoretical Domain Framework (TDF). Logistic regression assessed associations between TDF domains and both intentions to support and routine engagement in BZRA deprescribing. Major barriers (TDF items with mean < 3) were found in the goals (competing priorities), environmental context and resources (time and staff lack) and social influences (patient reluctance) domains. Five TDF domains were associated with a stronger intention to support deprescribing: social/professional role and identity (OR, 3.08; 95% CI, 1.77-5.46); beliefs about consequences (OR, 1.91; 95% CI, 1.07-3.34); memory, attention and decision processing (OR, 1.80; 95% CI, 1.16-2.82); intention to promote alternatives (OR, 1.63; 95% CI, 1.07-2.49); and reinforcement (OR, 1.57; 95% CI, 1.08-2.29). Knowledge was the only domain associated with routine BZRA deprescribing support (OR, 1.16; 95% CI, 1.06-1.27). Different categories of HCPs face similar major barriers, but barriers vary across HCP categories and countries. Context-specific, targeted interventions may enhance support for BZRA deprescribing.

Keywords: benzodiazepines; deprescribing; medication safety; nonphysician staff; older adults.