Enrico Callegari

• López-Toribio, María; Dalleur, Olivia; Adda, Tokandji Rostand; Saint-Hubert, Marie De; Dikeos, Dimitris & Tsoutsi, Vagioula [Vis alle 19 forfattere av denne artikkelen] (2025). Mapping care trajectories for hospital-initiated benzodiazepine deprescribing in older adults: a multicentre qualitative study. BMC Health Services Research. 25(1). doi: 10.1186/s12913-025-13725-2. Fulltekst i vitenarkiv Vis sammendrag

  Background Long-term prescription of benzodiazepine receptor agonists (BZRAs) for insomnia in adults over 65 years of age is considered a low-value care practice. Although deprescribing has emerged as a possible solution, the implementation of BZRA deprescribing has been considered insufficient in routine clinical care. Mapping care trajectories relative to BZRA deprescribing can help identify inefficiencies in current care and propose strategies to enhance the implementation of deprescribing interventions in the long term. This study aims to map care trajectories and characterise contextual factors relevant to hospital-initiated BZRA deprescribing in older adults. Methods A qualitative study was conducted with local researchers, healthcare professionals (HCPs), patients, and informal carers in six European countries (Belgium, Greece, Norway, Poland, Spain, and Switzerland). Three theoretical frameworks were used to guide data collection and analyses: 1) the ‘6W’ multidimensional model of care trajectories; 2) the patient-centred deprescribing process; and 3) the Context and Capabilities for Integrating Care framework. Data was collected online through self-administered questionnaires, individual interviews, and group validation interviews. Data were transcribed verbatim and analysed using a combination of deductive and inductive thematic analyses. Results We collected 18 responses to surveys, and conducted 53 interviews (6 local researchers, 36 HCPs, 11 patients or informal carers) and 7 group interviews (comprising 28 HCPs, 4 patients). We developed nine validated care trajectory maps by hospital department and type of unit, and two general comparative maps for inpatient and outpatient care. Hospital-initiated BZRA deprescribing emerged as a complex healthcare process that is likely to involve several HCPs from hospital and primary care. Participants considered patient involvement in shared decision-making (SDM) to be crucial in deprescribing, but implementation was scarce in routine care. The type of HCPs involved and the communication channels between them were specific to each country. Fragmented care and poor communication in the care trajectory hindered follow-up and continuity of care. Conclusions Deprescribing interventions should include context-sensitive strategies to promote patient participation in SDM, foster the use of guidelines, and enhance interprofessional collaboration along the care trajectory. Care trajectory maps can be used as an implementation tool to translate BZRA deprescribing interventions into routine practice.

• Shapoval, Vladyslav; Hubert, Marie de Saint; Pétein, Catherine; Viaud, Claire; Adda, Tokandji & Aubert, Carole Elodie [Vis alle 21 forfattere av denne artikkelen] (2025). Barriers to discontinuing benzodiazepine receptor agonists in older adults: a survey of older adults across Europe. Age and Ageing. ISSN 0002-0729. 54(12). doi: 10.1093/ageing/afaf342. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background Various factors hinder older adults from discontinuing benzodiazepine receptor agonists (BZRAs). Identifying and prioritising these barriers is essential for designing effective interventions to discontinue BZRAs. Objective To identify barriers to BZRA discontinuation among older adults and factors associated with their willingness to reduce or stop use. Methods A cross-sectional survey was conducted among adults 65+ using BZRA for sleep problems, recruited from hospitals across six European countries. Barriers were identified via a 27-item questionnaire grounded in the Theoretical Domains Framework (TDF), which systematically identifies individual and contextual determinants of behaviour. Responses were analysed using descriptive statistics. Multivariable logistic regressions identified factors associated with patients’ willingness to reduce or stop BZRA. Results Among 183 participants, 59.1% were willing to reduce and 42.7% to stop BZRA if recommended by their doctor. Half understood why discontinuation is necessary. Barriers were present for most participants across multiple TDF domains. They included: high satisfaction with BZRA, perceived low risk of side effects, limited coping skills or ability to stop, fear of discontinuation and lack of support from physicians or social networks. Higher scores in the TDF domains of Goals, Emotion and Social Influences were associated with greater willingness to reduce BZRA. These domains and Reinforcement, Environmental context and resources were also linked to a greater willingness to stop. Conclusions These findings highlight the opportunities and challenges of discontinuing BZRA in older adults. While half know the need to discontinue and are willing to try, future interventions must address pervasive barriers across many behavioural domains.

• Shapoval, Vladyslav; Evrard, Perrine; Sibille, François‐Xavier; López‐Toribio, María; Dalleur, Olivia & Aubert, Carole E. [Vis alle 19 forfattere av denne artikkelen] (2025). Barriers to and Enablers of Supporting Deprescribing Benzodiazepines in Older Adults: A Survey of European Nonphysician Healthcare Professionals. Basic & Clinical Pharmacology & Toxicology. ISSN 1742-7835. 137(4). doi: 10.1111/bcpt.70100. Fulltekst i vitenarkiv Vis sammendrag

  Although physicians are primarily responsible for Benzodiazepine Receptor Agonist (BZRA) deprescribing, nonphysician healthcare professionals (HCPs) can support deprescribing. This study explored barriers to and enablers of BZRA deprescribing among nonphysician HCPs. We surveyed 258 HCPs (63.2% nurses) working in hospital settings across six European countries using a questionnaire based on the Theoretical Domain Framework (TDF). Logistic regression assessed associations between TDF domains and both intentions to support and routine engagement in BZRA deprescribing. Major barriers (TDF items with mean < 3) were found in the goals (competing priorities), environmental context and resources (time and staff lack) and social influences (patient reluctance) domains. Five TDF domains were associated with a stronger intention to support deprescribing: social/professional role and identity (OR, 3.08; 95% CI, 1.77–5.46); beliefs about consequences (OR, 1.91; 95% CI, 1.07–3.34); memory, attention and decision processing (OR, 1.80; 95% CI, 1.16–2.82); intention to promote alternatives (OR, 1.63; 95% CI, 1.07–2.49); and reinforcement (OR, 1.57; 95% CI, 1.08–2.29). Knowledge was the only domain associated with routine BZRA deprescribing support (OR, 1.16; 95% CI, 1.06–1.27). Different categories of HCPs face similar major barriers, but barriers vary across HCP categories and countries. Context‐specific, targeted interventions may enhance support for BZRA deprescribing.

• Shapoval, Vladyslav; Hubert, Marie de Saint; Evrard, Perrine; Sibille, François-Xavier; Aubert, Carole E. & Bolt, Lucy [Vis alle 18 forfattere av denne artikkelen] (2025). Barriers to Deprescribing Benzodiazepines in Older Adults in a Survey of European Physicians. JAMA Network Open. 8(3). doi: 10.1001/jamanetworkopen.2024.59883. Fulltekst i vitenarkiv Vis sammendrag

  Importance The use of benzodiazepine receptor agonists (BZRA) poses serious health risks to older adults. Although several guidelines recommend deprescribing, implementation in clinical practice remains limited. Objective To identify physicians’ barriers to and enablers of deprescribing BZRA in adults aged 65 years and older taking a BZRA for sleep problems; to determine factors associated with hospital physicians’ intention to deprescribe BZRA and their self-reported routine BZRA deprescribing. Design, Setting, and Participants This survey study included hospital physicians and general practitioners (GPs) working across 6 European Countries (Belgium, Greece, Norway, Poland, Spain, and Switzerland) between December 2022 and March 2023. Main Outcomes and Measures Barriers identification via a 35-item questionnaire based upon the Theoretical Domains Framework (TDF). Responses were categorized as major barriers, moderate barriers, and enablers based on their mean scores. Multivariable logistic regressions were used to identify background characteristics and TDF-based domains associated with hospital physicians’ intention to deprescribe and self-reported routine deprescribing. Results Questionnaires from 240 hospital physicians and 96 GPs were analyzed. Most participants were women: 144 (61.0%) hospital physicians and 52 (54.2%) GPs. In terms of experience, the most common reported time in practice was less than 5 years for hospital physicians (76 [31.7%]) and between 10 and 14 years for GPs (35 [36.5%]). Most reported deprescribing BZRA routinely (135 hospital physicians [57.2%] and 66 GPs [72.5%]). Major barriers (and TDF domains) were similar for hospital physicians and GPs across the 6 countries. These barriers included: lack of training (skills), low self-efficacy (beliefs about capabilities), prioritization of other health issues (goals), frustration with the challenges of deprescribing (emotions), insufficient staff and time, absence of local policies (environmental context and resources), and reluctance from patients (social influence). Intention to deprescribe was significantly associated with country, occupation type, and 5 TDF domains: memory, attention, and decision process (odds ratio [OR], 1.70; 95% Ci, 1.22-2.40); social and/or professional role and identity (OR, 5.92; 95% CI, 3.28-11.07); beliefs about capabilities (OR, 2.35; 95% CI, 1.55-3.63); beliefs about consequences (OR, 3.00; 95% CI, 1.61-5.71); and reinforcement (OR, 1.49; 95% CI, 1.05-2.15). Routine deprescribing was significantly associated with 3 TDF domains: memory, attention, and decision processes; intentions; and emotions. Conclusion In this theory-based survey study of physicians, physicians and general practitioners described numerous barriers to deprescribing BZRA in older adults. Our findings indicate that effective deprescribing efforts require approaches that address both reflective processes (eg, enhancing capability) and impulsive processes (eg, managing emotions).

• Sibille, François-Xavier; Salbert, Joanna; Bolt, Lucy; Tsoutsi, Vagioula; Callegari, Enrico & Dalleur, Olivia [Vis alle 20 forfattere av denne artikkelen] (2025). Equipping physicians for benzodiazepine receptor agonists deprescription in older adults: theory-based development of the BE-SAFE intervention. Research in Social and Administrative Pharmacy. ISSN 1551-7411. 21(9), s. 714–721. doi: 10.1016/j.sapharm.2025.05.002. Fulltekst i vitenarkiv Vis sammendrag

  Background Benzodiazepine receptor agonists (BZRA) are still widely used for sleep problems in older adults despite an unfavourable risk-benefit ratio. The hospital setting presents an opportunity for optimising medication use in older adults. The BE-SAFE project follows a rigorous sequential approach for developing a theory-informed intervention towards BZRA deprescription initiated in the hospital setting in 6 European countries (Belgium, Greece, Norway, Poland, Spain, and Switzerland). Objectives The objectives of this paper are to describe the development of the physicians' intervention, the results of on the acceptability and perceived feasibility with physicians, and the finalised BE-SAFE intervention. Methods The intervention was built upon preliminary work and developed in four main steps: selection of behaviour change techniques; identification of existing resources and assessment of needs and preferences of hospital physicians; development of intervention components and modes of delivery; and end-users’ evaluation and refinement of intervention. Results A total of 11 behaviour change techniques were selected, addressing 6 main barriers into a 6-component intervention: senior physician endorsement, training, self-monitoring, deprescription algorithm, communication to patients and other healthcare professionals. These core elements will be delivered allowing local adaptability. Twenty-four physicians evaluated the intervention. They confirmed that the intervention effectively targets the barriers highlighted in preliminary work and provided feedback for improvement regarding clarity and time issues. Conclusions A 6-component physician's intervention to enhance BZRA deprescription initiated in hospital settings was developed by systematically addressing implementation issues in a theory informed manner. This intervention will be evaluated in a multi-country cluster randomised controlled trial.

• Callegari, Enrico; Benth, Jurate Saltyte; Selbæk, Geir; Grønnerød, Cato & Bergh, Sverre (2022). The Effect of the NorGeP–NH on Quality of Life and Drug Prescriptions in Norwegian Nursing Homes: A Randomized Controlled Trial. Pharmacy. ISSN 2226-4787. 10(1). doi: 10.3390/pharmacy10010032. Fulltekst i vitenarkiv Vis sammendrag

  Background: The effect of the Norwegian General Practice–Nursing Home (NorGeP–NH) criteria has never been tested on clinical outcomes in nursing home (NH) residents. We performed a cluster-randomized trial in Norwegian NHs and tested the effect of NorGeP–NH on QoL (primary outcome), medication prescriptions, and physical and mental health (secondary outcomes) for the enrolled residents; Methods: Fourteen NHs were randomized into intervention NHs (iNHs) and control NHs (cNHs). After baseline data collection, physicians performed NorGeP–NH on the enrolled residents. We assessed the difference between cNHs and iNHs in the change in primary outcome from baseline to 12 weeks and secondary outcomes from baseline to eight and 12 weeks by linear mixed models; Results: One hundred and eight residents (13 lost to follow-up) and 109 residents (nine lost to follow-up) were randomized to iNHs and cNHs, respectively. Difference in change in QoL at 12 weeks between cNHs and iNHs was not statistically significant (mean (95% CI)): −1.51 (−3.30; 0.28), p = 0.101). We found no significant change in drug prescriptions over time. Difference in depression scores between cNHs and iNHs was statistically significant after 12 weeks. Conclusions: Our intervention did not affect QoL or drug prescriptions, but reduced depression scores in the iNHs. NorGeP–NH may be a useful tool, but its effect on clinical outcomes may be scarce in NH residents. Further studies about the effectiveness of NorGeP–NH in other healthcare contexts and settings are recommended.

• Callegari, Enrico; Benth, Jurate Saltyte; Selbæk, Geir; Grønnerød, Cato & Bergh, Sverre (2021). Do prescription rates of psychotropic drugs change over three years from nursing home admission? BMC Geriatrics. 21(1), s. 1–15. doi: 10.1186/s12877-021-02437-x. Fulltekst i vitenarkiv Vis sammendrag

  Background: In this longitudinal study, we describe how psychotropic drugs (PTDs) are prescribed in nursing home (NH) patients from admission and over a 3-year period, to understand which clinical and environmental factors are associated with PTD prescription. Methods: We used data from the Resource Use and Disease Course in Dementia - Nursing Home (REDIC-NH) study, examining physical and mental health, dementia, and PTD prescription during a 3-year period from admission to a NH. Data were collected every six months. At baseline, we included 696 participants from 47 Norwegian NHs. We presented prevalence, incidence, and deprescribing rates of PTD prescriptions for each assessment point. We calculated the odds of receiving PTDs and used a generalized linear mixed model to analyze the variables associated with a change in odds throughout the 3-year period. Results: PTD prescriptions were frequent throughout the 3-year period. Antidepressants had the highest prescription rates (28.4%-42.2%). Every PTD category had the highest incidence rate between admission and six months, and antipsychotics had the highest values (49.4%). Deprescribing rates were comparable between assessment points. The odds of antipsychotic prescriptions were lower for older people (OR = 0.96, 95%CI:0.92-0.99, p = 0.023). People with more severe dementia had lower odds of being prescribed sedatives/hypnotics (OR = 0.89, 95%CI:0.85-0.94, p < 0.001). Conclusions: PTDs, particularly antidepressants, are widely prescribed over time to NH patients. Older patients are less likely to receive antipsychotics. A higher severity of dementia decreases the odds of being prescribed sedatives/hypnotics. Close attention should be paid to PTD prescriptions during long-term NH stay to avoid prolonged and excessive treatment with these types of drugs. Trial registration: ClinicalTrials.gov Identifier: NCT01920100 . Keywords: Geriatric pharmacotherapy; Nursing homes; Psychotropic drugs. © 2021. The Author(s).

• Callegari, Enrico; Benth, Jūratė Šaltytė; Selbæk, Geir; Grønnerød, Cato & Bergh, Sverre (2020). Does Psychotropic Drug Prescription Change in Nursing Home Patients the First 6 Months After Admission? Journal of the American Medical Directors Association. ISSN 1525-8610. 22(1), s. 101–108. doi: 10.1016/j.jamda.2020.08.034. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: To explore the course of psychotropic drug (PTD) prescription from admission (BL) to 6-month follow-up (6m) in Norwegian nursing homes (NHs). To examine how clinical variables, such as neuropsychiatric symptoms (NPS), cognition, physical health, and NH characteristics at BL are associated with prescription rates at 6 months. Design: An observational longitudinal cohort study (data from the Resource Use and Disease Course in Dementia-Nursing Home study) designed to examine the course of dementia, psychiatric and somatic diseases, and drug prescriptions in NH patients during the first 6 months after admission. Setting and participants: We included 696 patients at admission to 47 representative Norwegian NHs. Methods: Demographic and clinical characteristics at BL and 6m are presented. Dementia severity was assessed by the Clinical Dementia Rating scale and the Functional Assessment Staging of Alzheimer's Disease scale. Final diagnosis was made by 2 of the authors (G.S. and S.B.) according to ICD-10 criteria. Prevalence, incidence, and persistence rates of PTD prescriptions for people with dementia are presented. Generalized mixed models were used to identify possible predictors for the course of PTD prescription from BL to 6m. Results: Prescription rates of antidepressants, antipsychotics, anxiolytics, sedatives, and hypnotics increased in people with dementia from BL (67.5% received at least 1 PTD) to 6m (74.0% received at least 1 PTD). Younger age and higher Neuropsychiatric Inventory-affective subsyndrome score at BL were associated with higher odds of antidepressant prescription, whereas patients with higher comorbidity at BL had lower odds of receiving antidepressants, both at BL and 6m. Higher Neuropsychiatric Inventory-affective subsyndrome scores at BL were associated with higher odds of sedative and hypnotic prescription at both assessment points. Conclusions and implications: PTD prescription rates increase from BL to 6m. Medication appropriateness should be frequently evaluated after admission to optimize PTD prescriptions. Keywords: Psychotropic drugs; geriatric pharmacotherapy; nursing homes. Copyright © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

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• Callegari, Enrico; Benth, Jurate Saltyte; Selbæk, Geir; Grønnerød, Cato & Bergh, Sverre (2022). Correction: Do prescription rates of psychotropic drugs change over three years from nursing home admission? (BMC Geriatrics, (2021), 21, 1, (496), 10.1186/s12877-021-02437-x). BMC Geriatrics. 22(1). doi: 10.1186/s12877-022-03486-6. Fulltekst i vitenarkiv

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