Supporting general practitioners to deprescribe benzodiazepines and Z-drugs in primary care: finding from a modified Delphi study

Long-term use of benzodiazepines and Z-drugs (collectively known as benzodiazepine receptor agonists; BZRAs) is associated with a range of adverse effects including dependence and withdrawal on stopping or reducing the dose. Deprescribing is recommended to improve patient outcomes and reduce medication-related harm, but its implementation in primary care is hindered by various barriers. This study aimed to identify the strategies that Australian general practitioners (GPs) agree were most useful in supporting them to deprescribe BZRAs. A modified Delphi was conducted online over three rounds with 38 Australian GPs. Participants were registered GPs with ≥ 10 years' experience in either addiction, mental health, sleep, pain management, or aged care. Participants rated and provided feedback on 61 implementation strategies over three rounds until they achieved either consensus or stability. Included strategies were mapped to the theoretical domains framework to understand their links to behaviour change mechanisms. Twenty-five strategies reached a consensus for inclusion indicating their importance to supporting GPs to deprescribe BZRAs. The most important strategies included extended consultation times, provision of clear deprescribing protocols and establishing practice-level agreement on deprescribing policies. 

Findings provide a prioritised set of implementation strategies to address the barriers to BZRA deprescribing and offer a strong foundation for future research and policy to improve deprescribing in primary care.