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
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.