In contrast to the majority of community-based settings, the number of prescriptions for benzodiazepines (BZD) has decreased among older veterans. For a study, researchers sought to identify health care system measures linked with larger facility-level BZD prescribing reductions in older persons. They concluded an explanatory sequential mixed-methods analysis of Veterans Health Administration health care facilities (N=140). They divided institutions into relatively high and low-performance categories based on the reduction in an average daily dose of prescription BZD from October 1, 2015, to June 30, 2017, for veterans aged more or around 75 years receiving long-term BZD treatment. Then, they interviewed important facility informants (n=21) who led local BZD reduction initiatives (champions) for 11 high-performing institutions and 6 low-performing facilities. In October 2015, the age-adjusted facility-level average daily dose was 1.34 lorazepam-equivalent mg/d (SD 0.17); the average rate of decline was -0.27 mg/d (SD 0.09) per year. Regardless of performance, every facility that was questioned used passive strategies, including educating staff members on appropriate prescribing, alternative treatment options, and identifying patients who were likely candidates for quitting smoking. Champions in high-performing hospitals, on the other hand, acknowledged the use of more or around 1 active method to reward physicians. This method included personalized suggestions, administrative hurdles to prescribing, and performance measures. It was possible that efforts to restrict prescribing BZDs to older people that relied primarily on passive measures, such as education and patient identification, would have little impact. It might be helpful for clinicians to have additional guidelines, support, and incentives when trying to change prescribing behaviors.

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