Clinician Perspectives of Benzodiazepine Receptor Agonists (BZRA) Prescribing and Deprescribing in Ontario

Background: BZRAs are commonly prescribed to older adults for the acute treatment of insomnia and anxiety, despite evidence-based recommendations cautioning against it due to an increased risk for falls/fractures, cognitive impairment and dependence, coupled with the added risk from inappropriate polypharmacy. Deprescribing BZRAs among older adults is challenging due to the many stakeholders involved (i.e., patient, clinicians, environment). Further, the prescribing/deprescribing landscape of BZRAs within smaller mixed urban-rural regions such as Southwestern Ontario has yet to be thoroughly investigated where access to resources and care coordination may differ. Objective: This study aims to explore clinician perspectives influencing BZRA prescribing/deprescribing practices within smaller mixed urban-rural regions in Ontario. Proposed Methods: This study employs a qualitative research design. Clinicians (primary care physicians, geriatricians, nurse practitioners) providing care to older adults within smaller mixed urban-rural regions in Ontario are invited to participate in a 30-45-minute semi-structured interview. Participants are asked about their rationale and perceived indications for prescribing BZRAs, the BZRA prescribing process and deprescribing efforts (including challenges/enablers). A directed content analysis using the Theoretical Domains Framework will be used for data analysis to identify emerging patterns and themes. Future applications: Findings may demonstrate a theoretical understanding of factors influencing BZRA prescribing/deprescribing practices among clinicians in smaller mixed urban-rural regions of Ontario. This study will provide a preliminary contextual understanding critical to developing BZRA prescribing initiatives that account for the health and social complexities within these understudied regions of Ontario.