With the concomitant treatment of multi-morbidities in older adults (age 65+ years), inappropriate polypharmacy has been increasingly prevalent among this population. Benzodiazepine receptor agonists (BZRAs) are commonly prescribed to older adults for the acute treatment of insomnia and anxiety, despite evidence-based recommendations that caution against it. Prolonged BZRA use (beyond 4-6 weeks) often contributes to inappropriate polypharmacy in this demographic, leading to an increased risk for falls/fractures, cognitive impairment, and dependence. However, deprescribing BZRAs has been fraught with many challenges stemming from the patient (i.e., fears of withdrawal, lack of motivation or awareness of risks), and clinician (i.e., lack of systematic strategy, knowledge, and confidence). Furthermore, BZRA deprescribing literature within Ontario has primarily been studied within the context of large urban academic centres. This may limit the generalizability of findings and recommendations to regions, such as Southwestern Ontario, which comprise mixed rural-urban settings, whereby care coordination and access to resources may differ. Using qualitative research methodology, this practice-based research project will explore clinician (physician and nurse practitioner) perspectives influencing BZRA prescribing/deprescribing within Southwestern Ontario, through individual interviews. Clinicians are well-positioned at the intersection of patients and the healthcare system to provide insight into the barriers/facilitators to deprescribing BZRAs. Data will be analyzed using a directed content analysis guided by the Theoretical Domains Framework. This project will provide a preliminary contextual understanding to support the development of BZRA deprescribing and quality improvement initiatives and capacity-building for BZRA deprescribing in clinicians and patients in Southwestern Ontario.

This study aims to explore clinician perspectives on the perceived factors influencing BZRA prescribing and deprescribing for older adults residing within Southwestern Ontario. Based on a systematic review by Rasmussen et al. (2021), it is hypothesized that clinicians will highlight more barriers to deprescribing BZRAs than facilitators.