Factors Associated With Benzodiazepine and Antipsychotic Prescribing in Hospice: A Qualitative Study of Hospice Prescribers.

Autor:	Gerlach LB; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. Electronic address: glauren@umich.edu., Turnwald M; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA., Geczi K; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA., O'Neil T; Arbor Hospice, Ann Arbor, MI, USA., Watkins D; School of Social Work, University of Michigan, Ann Arbor, MI, USA., Bynum JPW; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA., Maust DT; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Jazyk:	angličtina
Zdroj:	Journal of the American Medical Directors Association [J Am Med Dir Assoc] 2023 Sep; Vol. 24 (9), pp. 1297-1302.e1. Date of Electronic Publication: 2023 May 22.
DOI:	10.1016/j.jamda.2023.04.007
Abstrakt:	Objectives: Benzodiazepine and antipsychotic medications are common components of the hospice toolkit and are routinely prescribed for behavioral symptom management at end of life. These medications have significant associated risks but, despite their frequent use, little is known about how clinicians weigh prescribing decisions for individuals in hospice. In this qualitative study, we examined the key factors that influence the decision to initiate a benzodiazepine and antipsychotic medication for management of behavioral symptoms at end of life. Design: A qualitative study using semi-structured interviews and descriptive qualitative analysis. Setting and Participants: We conducted semi-structured interviews with prescribing hospice physicians and nurse practitioners working in hospice settings across the United States. Methods: Hospice clinicians were asked to describe factors that influence prescribing decisions to initiate benzodiazepine and antipsychotic medications for the management of behavioral symptoms. Data from audio-recorded sessions were transcribed, coded to identify relevant concepts, and reduced to determine major themes. Results: We completed 23 interviews with hospice physicians and nurse practitioners. On average, participants had worked in a hospice setting for a mean of 14.3 years (SD: 10.9); 39% had geriatrics training. Major themes related to benzodiazepine and antipsychotic prescribing were (1) caregiving factors strongly influence the use of medications, (2) patient and caregiver stigma and concerns regarding medication use limit prescribing, (3) medications are initiated to avoid hospitalization or transition to a higher level of care, and (4) nursing home hospice care brings unique challenges. Conclusion and Implications: Caregiver factors and the setting of hospice care strongly influence clinician decisions to initiate benzodiazepines and antipsychotics in hospice. Caregiver education about medication use at end of life and support in managing challenging behaviors may help promote optimal prescribing. (Copyright © 2023 AMDA – The Society for Post-Acute and Long-Term Care Medicine. All rights reserved.)
Databáze:	MEDLINE
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