Evaluating the Implementation of a Multicomponent Intervention Consisting of Education and Feedback on Reducing Benzodiazepine Prescriptions by General Practitioners: BENZORED Hybrid Type I Cluster Randomized Controlled Trial

Isabel Socias, Alfonso Leiva, Haizea Pombo-Ramos, Ferran Bejarano, Ermengol Sempere-Verdú, Raquel María Rodríguez-Rincón, Francisca Fiol, Marta Mengual, Asunción Ajenjo-Navarro, Fernando Do Pazo, Catalina Mateu, Silvia Folch, Santiago Alegret, Jose Maria Coll, María Martín-Rabadán and Caterina Vicens
Additional contact information
Isabel Socias: Healthcare Centre Manacor, Balearic Health Service IbSalut, 07500 Manacor, Spain
Alfonso Leiva: Balearic Islands Health Research Institute (IdISBa), 07120 Palma, Spain
Haizea Pombo-Ramos: Primary Care Research Unit of Biscaia, Basque HealthCare Service Osakidetza, BioCruces Health Research Institute, 48903 Bizkaia, Spain
Ferran Bejarano: Catalunya Health Services-CatSalut, DAP Camp de Tarragona, 43002 Tarragona, Spain
Ermengol Sempere-Verdú: Paterna Healthcare Centre, Conselleria de Sanitat Universal i Salut Pública, 46980 Valencia, Spain
Raquel María Rodríguez-Rincón: Pharmacy Department, Hospital Universitari Son Espases, Balearic Health Service IbSalut, 07120 Palma, Spain
Francisca Fiol: Balearic Islands Health Research Institute (IdISBa), 07120 Palma, Spain
Marta Mengual: Catalunya Health Services-CatSalut, DAP Camp de Tarragona, 43002 Tarragona, Spain
Asunción Ajenjo-Navarro: Paterna Healthcare Centre, Conselleria de Sanitat Universal i Salut Pública, 46980 Valencia, Spain
Fernando Do Pazo: Pharmacy Department, Hospital Universitari Son Espases, Balearic Health Service IbSalut, 07120 Palma, Spain
Catalina Mateu: Son Serra-La Vileta Healthcare Centre, Balearic Health Service IbSalut, 07013 Palma, Spain
Silvia Folch: Catalunya Health Services-CatSalut, DAP Camp de Tarragona, 43002 Tarragona, Spain
Santiago Alegret: Son Serra-La Vileta Healthcare Centre, Balearic Health Service IbSalut, 07013 Palma, Spain
Jose Maria Coll: Menorca Primary Care Management, Balearic Health Service IbSalut, 07701 Maó, Spain
María Martín-Rabadán: Can Misses Healthcare Centre Ibiza, Balearic Health Service IbSalut, 07800 Ibiza, Spain
Caterina Vicens: Balearic Islands Health Research Institute (IdISBa), 07120 Palma, Spain

IJERPH, 2021, vol. 18, issue 15, 1-13

Abstract: Background: General practitioners (GPs) in developed countries widely prescribe benzodiazepines (BZDs) for their anxiolytic, hypnotic, and muscle-relaxant effects. Treatment duration, however, is rarely limited, and this results in a significant number of chronic users. Long-term BZD use is associated with cognitive impairment, falls with hip fractures, traffic accidents, and increased mortality. The BENZORED IV trial was a hybrid type-1 trial conducted to evaluate the effectiveness and implementation of an intervention to reduce BZD prescription in primary care. The purpose of this qualitative study was to analyze the facilitators and barriers regarding the implementation of the intervention in primary care settings. Methods: A qualitative interview study with 40 GPs from three Spanish health districts. Focus group meetings with GPs from the intervention arm of the BENZORED IV trial were held at primary healthcare centers in the three districts. For sampling purposes, the GPs were classified as high or low implementers according to the success of the intervention measured at 12 months. The Consolidated Framework for Implementation Research (CFIR) was used to conduct the meetings and to code, rate, and analyze the data. Results: Three of the 41 CFIR constructs strongly distinguished between high and low implementers: the complexity of the intervention, the individual Stage of Change, and the key stakeholder’s engagement. Seven constructs weakly discriminated between the two groups: adaptability in the intervention, external policy and incentives, implementation climate, relative priority, self-efficacy, compatibility, and engaging a formally appointed implementation leader. Fourteen constructs did not discriminate between the two groups, six had insufficient data for evaluation, and eleven had no data for evaluation. Conclusions: We identified constructs that could explain differences in the efficacy in implementation of the intervention. This information is relevant for the design of successful strategies for implementation of the intervention.

Keywords: benzodiazepines; adverse effects; primary health care; deprescribing; clinical trial (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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