PRP096: Feasibilities and effectiveness of benzodiazepine de-prescribing QI initiatives among primary care clinics in Japan.

MASAHIRO NISHIMURA, MD; Masakazu Nakamura, MD; Takahiro Mochizuki, MD; Daisuke Yamashita, MD

Abstract

Context: Overusage of benzodiazepines may cause harm and dependence, especially for those living in an aging country like Japan. Quality improvement (QI) in the primary care setting in Japan is scarce, and this may be an obstacle to benzodiazepine deprescribing intitiatives. Objective: To determine whether the Clinical Audit and QI coaching are feasible and effective in the context of benzodiazepine de-prescribing among primary care clinics in Japan. Study Design: a mixed-methods study. Setting: Primary care setting in Japan. The population studied: We will measure nine rural clinics' clinical performance related to benzodiazepine prescriptions as well as perceptions of medical staff. Intervention: We will randomize the clinics to receive either Clinical Audit(monthly reports of benzodiazepine patients and benzodiazepine prescriptions) or Clinical Audit and QI Coaching. In the “Clinical Audit” plus “QI Coaching” group, the coach will offer a 1:1 web meeting, consisting of QI knowledge-based lectures, and personal coaching. Outcome Measures: 1 )Semi-structured interview with clinicians and medical staff about their experiences with QI and benzodiazepine deprescribing. 2)Surveys at the pre and post point of this intervention regarding experiences with QI and benzodiazepine de-prescribing. 3)Pre-post intervention comparison of “the ratio of number of patients which include at least one medication of benzodiazepine per month” and “the changing ratio of total number of benzodiazepine prescription’s days per month”. Results: We will identify enablers and barriers for implementing benzodiazepine de-prescribing QI activities and their effectiveness by analyzing the quantitative measures. Conclusions: This is a first trial to seek the feasibility and efficacy of quality improvement activities of benzodiazepine de-prescribing in the Japanese primary care setting, which will serve as a foundation to implement QI activities in Primary Care practices throughout Japan.
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Makoto Kaneko
makotokaneko0314@gmail.com 11/25/2020

Great work! In Japan, there are very few studies of QI. This is very relevant to Japanese patients and primary care doctors. My questions are: ・How do you adjust or deal with confounders? Many factors can influence the outcomes. ・Will you explore patients' perspectives? Some patients who take BZD for a long time would like to continue BZD. ・Who do conduct interview? A physician in the same clinic? Or a researcher? The interviewer's position or relationship with the participants can affect the results. ・How is the burden to collect the data by File maker. I sometimes experienced burden for collecting data unable to carry on research.

Masahiro Nishimura
nishimuram@jadecom.jp 12/9/2020

Thank you for your good questions! ・How do you adjust or deal with confounders? Many factors can influence the outcomes. →Study aim is not prove the QI interventions and those impacts to benzo Rx. The aim is to study feasibility of QI coaching and its impact to the Japanese PC. We use QI run chart principle to determine the impact of QI which is different approach than pure cohort method. ・Will you explore patients' perspectives? Some patients who take BZD for a long time would like to continue BZD. →This is also an important question when we consider the quadruple aim of QI. But unfortunately, we will not measure the patient's perspectives this time. Let us bring this issue back as our next step, please. ・Who do conduct an interview? A physician in the same clinic? Or a researcher? The interviewer's position or relationship with the participants can affect the results. →I (PI, researcher) will do. I am, say, "a colleague" of them as the physician in JADECOM clinics. So I can say our relationship is not vertical, but horizontal. But I think your point makes sense. Our relationship may affect the outcome. ・How is the burden to collect the data by File maker. I sometimes experienced burden for collecting data unable to carry on research. →Ahead of this study, we established our own "data center" in JADECOM. And we are now trying to create a workflow to gather the EHR data(Receipt billing data set) as routine work for clinics. So far, data gathering goes well without any burden. But the problem is that we cannot get enough human resources(data manager or system engineer) to dedicate to this project. This will be our challenge to grow this project.

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