B-Safe Project
B-Safe: Promoting Safe Benzodiazepine Prescribing for Older Veterans
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Team Members: Donovan Maust, MD, MS (PI) Amy Bohnert, PhD, MHS Fred Blow, PhD Helen Kales, MD Sarah Krein, PhD, RN Lillian Min, MD, MSHS Becky Clive, BA Linda Takamine, MS Julie Strominger, MS Evelina Kutyma, MPH Funding: 2/1/2018 – 1/31/2022 Partners: VA Psychotropic Drug Safety Initiative (PDSI), Office of Mental Health and Suicide Prevention; VA Pharmacy Benefits Management |
Background: Benzodiazepine (BZD) use is a significant concern among older Veterans given their links with adverse outcomes including falls, fractures, motor vehicle accidents, impaired cognition, and mortality. In 2015, over 82,000 Veterans over 75 were prescribed a BZD—medications like lorazepam or alprazolam that are commonly used for sleep or anxiety—despite evidence of the harms and recommendations from organizations like the American Geriatrics Society to limit their use. Through the VA’s Psychotropic Drug Safety Initiative (PDSI), some facilities have been able to reduce BZD prescribing to older Veterans but it isn’t clear which strategies have been successful, and why. In addition, some strategies that appear “successful” at reducing prescribing might be extremely distressful to older Veterans if they aren’t well engaged in the process. The aim of this project is to identify successful strategies that both reduce BZD prescribing and are acceptable to older Veterans.
Objectives: The objective of this study is to collect and analyze quantitative and qualitative data from sites that implemented PDSI, and to use findings from these analyses to develop context-sensitive strategies for facilities to reduce both acute and chronic BZD use among older Veterans. This study will use national VA administrative data to examine BZD prescribing to Veterans under the age of 75 across 52 facilities that focused on BZD prescribing through participation in PDSI. Telephone interviews will be conducted with up to 16 PDSI local facility champions from top- and bottom-performing facilities, followed by on-site, semi-structured interviews with key stakeholders at up to 6 sites. We will gather information on facility-level strategies, barriers, and facilitators to implementing PDSI. We will also conduct telephone interviews with older Veterans prescribed chronic BZDs, who attempted a taper, to learn whether patients experienced these facility strategies as distressful. Finally, an expert panel of clinicians, researchers, and administrators will review the findings from this work to develop a toolkit of context-sensitive best practices facilities can implement to address BZD use. 
