Tongeren, S.D. van (2017) De-implementation of inappropriate benzodiazepines and other sedative hypnotics for elderly inpatients. thesis, Medicine.
Full text available on request.Abstract
Extensive research has shown that benzodiazepines and other sedative hypnotics (BSH) increase risk of falls, motor vehicle accidents and hip fractures greatly, especially in elderly patients. Nonetheless, they continue to be widely prescribed as a first choice agent for insomnia. De-implementation is the process of reducing inappropriate care. While insomnia remains to be taken seriously, de-implementing the use of BSH for insomnia will benefit a large population that now inappropriately take these drugs or might be inappropriately started on them. This study focuses on hospital-based efforts to curb inappropriate BSH usage in elderly inpatients across multiple countries. The goal is to analyze tried approaches to de-implementation and inform future efforts of BSH de-implementation, as well as to inform hospital based de-implementation of low-value care more broadly. Seven de-implementation projects were included representing thirteen hospitals from Canada, US and Switzerland, allowing for a comparison between different healthcare contexts. Eighteen semi-structured interviews took place with clinicians, executives and supportive non-clinical staff involved in the de-implementation projects. Qualitative analysis was based on a cross case analysis using the Consolidated Framework for Implementation Research (CFIR) framework as a taxonomy of relevant constructs. Projects deployed approaches tailored to their specific context. Several steps were identified as structural to any project. The need for a substitute treatment option was an important new finding. Context specific factors should be considered by future de-implementation projects to match their own context. Combined, the steps and tools described in this research present future BSH de-implementation projects with insights and suggestions. This research is a first exploration into the practical side of de-implementation for BSH in elderly inpatients across multiple health care contexts. Depending on certain characteristics of the hospital‘s and healthcare‘s context, we highlighted key enablers and barriers to BSH de-implementation. Results of this study can be used to guide de-implementation of inappropriate BSH use in other hospitals. Future research can focus on generalizability of these results to de-implementation of other forms of low value care and other healthcare settings.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisor UMCG: and Bultmann, Prof. dr. U. |
| Supervisor name: | Supervisors Choosing Wisely Canada: and Bhatia, Dr. R.S. MD and Born, K. PhD and Research locations: Choosing Wisely Canada. Toronto, Canada and Women‘s College Hospital Institute for Health System Solutio |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:55 |
| Last Modified: | 25 Jun 2020 10:55 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1546 |
Actions (login required)
 |
View Item |