• Donovan T Maust, Linda Takamine, Ilse R Wiechers, Frederic C Blow, BohnertAmy S BASBCenter for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.Department of Anesthesiology, University of Michigan,, Julie Strominger, Lillian Min, and Sarah L Krein.
• Department of Psychiatry, University of Michigan, Ann Arbor, Michigan maustd@umich.edu.
• Ann Fam Med. 2022 Jul 1; 20 (4): 328335328-335.

PurposeUnlike in many community-based settings, benzodiazepine (BZD) prescribing to older veterans has decreased. We sought to identify health care system strategies associated with greater facility-level reductions in BZD prescribing to older adults.MethodsWe completed an explanatory sequential mixed methods study of health care facilities in the Veterans Health Administration (N = 140). Among veterans aged ≥75 years receiving long-term BZD treatment, we stratified facilities into relatively high and low performance on the basis of the reduction in average daily dose of prescribed BZD from October 1, 2015 to June 30, 2017. We then interviewed key facility informants (n = 21) who led local BZD reduction efforts (champions), representing 11 high-performing and 6 low-performing facilities.ResultsAcross all facilities, the age-adjusted facility-level average daily dose in October 2015 began at 1.34 lorazepam-equivalent mg/d (SD 0.17); the average rate of decrease was -0.27 mg/d (SD 0.09) per year. All facilities interviewed, regardless of performance, used passive strategies primarily consisting of education regarding appropriate prescribing, alternatives, and identifying potential patients for discontinuation. In contrast, champions at high-performing facilities described leveraging ≥1 active strategies that included individualized recommendations, administrative barriers to prescribing, and performance measures to incentivize clinicians.ConclusionsInitiatives to reduce BZD prescribing to older adults that are primarily limited to passive strategies, such as education and patient identification, might have limited success. Clinicians might benefit from additional recommendations, support, and incentives to modify prescribing practices.© 2022 Annals of Family Medicine, Inc.

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