Clinical decision‐making in benzodiazepine deprescribing by healthcare providers vs. AI‐assisted approach

British Journal of Clinical Pharmacology, Год журнала: 2023, Номер 90(3), С. 662 - 674

Опубликована: Ноя. 11, 2023

Abstract Aims The aim of this study was to compare the clinical decision‐making for benzodiazepine deprescribing between a healthcare provider (HCP) and an artificial intelligence (AI) chatbot GPT4 (ChatGPT‐4). Methods We analysed real‐world data from Croatian cohort community‐dwelling patients ( n = 154) within EuroAgeism H2020 ESR 7 project. HCPs evaluated using pre‐established criteria assess discontinuation potential. research team devised tested AI prompts ensure consistency with HCP judgements. An independent researcher employed ChatGPT‐4 predetermined simulate decisions each patient case. Data derived human‐HCP were compared agreement rates Cohen's kappa. Results Both HPC ChatGPT identified (96.1% 89.6%, respectively), showing rate 95% κ .200, P .012). Agreement on four ranged 74.7% 91.3% (lack indication .352, < .001; prolonged use .088, .280; safety concerns .123, .006; incorrect dosage .264, .001). Important limitations GPT‐4 responses identified, including 22.1% ambiguous outputs, generic answers inaccuracies, posing inappropriate risks. Conclusions While AI‐HCP is substantial, sole reliance poses risk unsuitable decision‐making. This study's findings reveal both strengths areas enhancement in recommendations sample. Our underscores need additional functionality therapy decision‐making, further fostering advancement optimal performance.

Язык: Английский

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Patient Perceptions of Opioids and Benzodiazepines and Attitudes Toward Deprescribing

Drugs & Aging, Год журнала: 2023, Номер 40(12), С. 1113 - 1122

Опубликована: Окт. 4, 2023

Язык: Английский

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Ethical Aspects of Physician Decision-Making for Deprescribing Among Older Adults With Dementia

JAMA Network Open, Год журнала: 2023, Номер 6(10), С. e2336728 - e2336728

Опубликована: Окт. 3, 2023

Importance Physicians endorse deprescribing of risky or unnecessary medications for older adults (aged ≥65 years) with dementia, but there is a lack information on what influences decisions to deprescribe in this population. Objective To understand how physicians make moderate dementia and ethical pragmatic concerns influencing those decisions. Design, Setting, Participants A cross-sectional national mailed survey study random sample 3000 primary care from the American Medical Association Physician Masterfile who was conducted January 15 December 31, 2021. Main Outcomes Measures The randomized participants consider 2 clinical scenarios which physician may decide medication dementia: 1 could cause an adverse drug event if continued other no evidence benefit. ranked 9 factors related possible through best-worst scaling methods (from greatest barrier smallest deprescribing). Conditional logit regression quantified relative importance each factor as deprescribing. Results total 890 (35.0%) returned surveys; 511 (57.4%) were male, mean (SD) years since graduation 26.0 (11.7). Most had specialty family practice (50.4% [449 890]) internal medicine (43.5% [387 890]). 689 surveys sufficiently complete analyze. In both scenarios, barriers (1) patient reporting symptomatic benefit (beneficence autonomy) (2) having been prescribed by another (autonomy nonmaleficence). least influential ease paying (justice). Conclusions Relevance Findings suggests that understanding aspects decision-making can inform clinician education about management dementia.

Язык: Английский

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‘We need more support and doctors that understand the process of tapering …’: A content analysis of free‐text responses to a questionnaire on discontinuing long‐term benzodiazepine receptor agonist use

Health Expectations, Год журнала: 2024, Номер 27(1)

Опубликована: Янв. 7, 2024

Many individuals worldwide continue to take benzodiazepine receptor agonists (BZRAs) long term (≥3 months). The aim of this study was conduct a content analysis the views and experiences discontinuing long-term BZRA use as documented in free-text responses respondents an online questionnaire examining mediators behaviour change relating discontinuation use.

Язык: Английский

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Opioids and benzodiazepines in oncology: Perspectives on coprescribing and mitigating risks

Journal of Geriatric Oncology, Год журнала: 2024, Номер 16(2), С. 102172 - 102172

Опубликована: Дек. 14, 2024

Язык: Английский

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Provider knowledge, beliefs, and self‐efficacy to deprescribe opioids and sedative‐hypnotics

Journal of the American Geriatrics Society, Год журнала: 2022, Номер 71(5), С. 1580 - 1586

Опубликована: Дек. 22, 2022

While many studies have assessed and measured patient attitudes toward deprescribing, less quantitative research has addressed the provider perspective. We thus sought to describe knowledge, beliefs, self-efficacy deprescribe, with a focus on opioids sedative-hypnotics.An electronic anonymous survey was distributed primary care providers at Kaiser Permanente Washington. Two reminder emails were sent. The included 10 questions general six each specific opioid sedative-hypnotic deprescribing. Knowledge used multiple-choice response option format. Questions addressing beliefs (i.e., confidence) 0-10 Likert scale. Scales dichotomized ≥7 define agreement (belief questions) or confidence (self-efficacy questions). calculated descriptive statistics summarize responses.Of 370 eligible providers, 95 (26%) completed survey. For deprescribing questions, majority believed that lack of willingness, withdrawal symptoms fear symptom return, time constraints impeded Approximately half chose correct answers about 21% confident they could alleviate concerns tapering, 32% managing chronic non-cancer pain without opioids. sedative-hypnotics, 64%-87% respondents correctly answered risks relative effectiveness alternatives, but only one-third question tapering. Roughly in their ability successfully engage patients sedative conversations select alternatives. Only 54% 34% writing tapering protocol for respectively.Results suggest raising awareness willingness knowledge gaps, increasing are important targets improving Support protocols prescribing evidence-based drug non-drug alternatives may be improve care.

Язык: Английский

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Evaluation of the effectiveness of a joint general practitioner-pharmacist intervention on the implementation of benzodiazepine deprescribing in older adults (BESTOPH-MG trial): protocol for a cluster-randomized controlled trial

Frontiers in Medicine, Год журнала: 2023, Номер 10

Опубликована: Авг. 25, 2023

Deprescribing benzodiazepines and related drugs (BZDR) is a challenge due to lack of time on physicians' part, involvement other health professionals, the need for adapted tools. This study based primary care collaboration, by evaluating effectiveness joint intervention between general practitioners community pharmacists implementation BZDR deprescribing in older adults.This cluster randomized controlled trial which each will be formed physician-pharmacist pair. Within allocated intervention, pharmacist trained motivational interviewing (MI), offer patient 3 interviews after inclusion physician. They base their validated guidelines. The receive methodological support during first interviews. Interprofessional collaboration encouraged writing reports physician interview. following outcomes evaluated: acceptability/adoption, appropriateness, cost, fidelity. measured means sociological interviews, observations, logbooks, cost-utility analysis. Focus groups with physicians carried out identify levers barriers experienced this collaboration. Observations conducted assess approach MIs. Effectiveness medication (discontinuation or reduction BZDR) clinical (such as quality life, insomnia anxiety), assessed insurance databases questionnaires.This determine whether pharmacists, well training coaching interviewing, allows provide an understanding processes used implement guidelines, contribution collaborative practice implementing discontinuation. methodology allow experience relationship different actors, obstacles levers.The results obtained make it possible produce guidelines management substance abuse adults, even legislate new missions pathways.ClinicalTrials.gov, identifier, NCT05765656.

Язык: Английский

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TANGO: Development of Consumer Information Leaflets to Support TAperiNG of Opioids in Older Adults with Low Back Pain and Hip and Knee Osteoarthritis

Drugs & Aging, Год журнала: 2023, Номер 40(4), С. 343 - 354

Опубликована: Март 27, 2023

Globally, the rate of opioid prescription is high for chronic musculoskeletal conditions despite guidelines recommending against their use as adverse effects outweigh modest benefit. Deprescribing opioids a complex process that can be hindered by multiple prescriber- and patient-related barriers. These include fear of, or outcomes from, weaning medications, lack ongoing support. Thus, involving patients, carers, healthcare professionals (HCPs) in development consumer materials educate provide support patients HCPs over deprescribing critical to ensure resources have readability, usability, acceptability population interest. This study aimed (1) develop two educational leaflets tapering older people with low back pain (LBP) hip knee osteoarthritis (HoKOA), (2) evaluate perceived acceptability, credibility from perspective consumers HCPs. was an observational survey review panel HCP panel. 30 (and/or carers) 20 were included study. Consumers than 65 years age who currently experiencing LBP HoKOA, no background. Carers provided unpaid care, support, assistance individual meeting inclusion criteria consumers. physiotherapists (n = 9), pharmacists 7), orthopaedic surgeon 1), rheumatologist nurse practitioner 1) general all at least three clinical experience reported working closely this target patient within last 12 months. Prototypes (a brochure personal plan) developed team LBP, OA, geriatric pharmacotherapy researchers clinicians. The leaflet prototypes evaluated separate chronological panels and/or Data collection both occurred via online survey. Outcomes leaflets. Feedback received used refine leaflets, before circulating further Additional feedback then final versions Both plan usable, acceptable, credible. rated several categories, which scored between 53 97% positive responses. Similarly, overall 85–100% positive. modified System Usability Scale scores obtained 55–95% positive, indicating excellent usability. largely providing highest ratings (80–93%). While also high, we did identify prescribers hesitant frequently (no responses). led reduction HoKOA. incorporated maximise effectiveness future intervention implementation. Opioids are medications often treat severe pain. However, they serious not usually recommended long-term use. create taking materials' patients. panels. found credible groups. created reducing refined based on may useful supporting off opioids, various barriers related

Язык: Английский

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Pharmacist-Led Deprescribing of Opioids and Benzodiazepines in Older Adults: Examining Implementation and Perceptions

Pharmacy, Год журнала: 2024, Номер 12(4), С. 119 - 119

Опубликована: Июль 30, 2024

Background: This study examines the implementation and perceptions of a pharmacist consultant deprescribing program aimed at reducing risk falls in older adults using opioids benzodiazepines. Methods: qualitative conducted interviews with healthcare providers. The were from August to December 2021 analyzed inductive coding techniques. Results: Five participants, predominantly female MDs or PA-Cs rural clinics, interviewed. participants adopted pharmacist-led due their heightened awareness opioid crisis, dedication patient safety, desire for education. Initially, concerns included resistance provider-driven barriers. However, over time, attitudes shifted toward greater openness program. providers emphasized several critical needs success program: guaranteed access pharmacists, tailored education, resources specific providers, financial support, including telehealth options. These factors deemed essential overcoming initial barriers ensuring effective implementation. Conclusion: Integrating pharmacists into primary care settings shows promise benzodiazepines adults. Future research should explore options patient–pharmacist consultations expand application these findings other settings. highlights importance awareness, (pharmacists), provider support addressing among

Язык: Английский

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Exploring Opioid Management Challenges in Chronic Non-Tumor Pain: Findings from a Mixed-Methods Study among General Practitioners

Research Square (Research Square), Год журнала: 2024, Номер unknown

Опубликована: Авг. 10, 2024

Background: Germany has seen a significant increase in opioid prescriptions, particularly for high-potency opioids, despite limited evidence of their long-term efficacy chronic non-tumor pain. 87% these prescriptions are written by general practitioners. The high classified S3-LONTS guideline provides comprehensive recommendations responsible management. However, there is little insight into the implementation primary care. This study explores extent to which considered practice. Methods: A mixed-methods comprising an online survey and telephone interviews with practitioners was conducted assess four key recommendations: 1) Setting realistic treatment goals, 2) Using long-acting 3) Adhering fixed intake schedules, 4) Considering reduction or discontinuation responsive patients. Questionnaire data were analyzed descriptively through correlation analysis, while using inductive-deductive method based on Kuckartz. Results: total n=131 completed questionnaires n=21 analyzed. identified several gaps implementing nearly 50% did not set individualized, half preferred combining opioids intervals short-acting demand, about 16% used monotherapy error. Over discuss reducing discontinuing after six months effective pain relief. Qualitative analysis revealed barriers such as being inadequately informed, prioritizing personal experience over guidelines, lacking structured approach management, reluctant deprescribe due concerns compromising success. Conclusion: Barriers evidence-based management care may contribute overuse misuse. Structured programs, peer exchanges guidelines quality circles, stronger emphasis importance (continuing) medical training could enhance integration routine reduce therapy

Язык: Английский

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