JMIR Publications

ABSTRACT

Background:

Long-term dependence on prescribed benzodiazepines is a public health problem. Eliminating Medications Through Patient Ownership of End Results (EMPOWER) is a promising direct-to-patient self-management intervention, delivered via booklet, that is effective in promoting benzodiazepine reduction and cessation in older adults using long term benzodiazepines. EMPOWER has high potential to benefit the US Veterans Health Administration (VHA) which cares for many Veterans who use benzodiazepines over the longer-term.

Objective:

We aimed to adapt the original EMPOWER booklet materials for electronic delivery (termed EMPOWER-ED) and for use among Veterans receiving care in VHA with evidence of long-term benzodiazepine use.

Methods:

We used elements of Analysis, Design, Development, Implementation and Evaluation (ADDIE) -- a framework commonly used in the field of instructional design, to iteratively adapt EMPOWER for electronic delivery. We conducted three waves of focus groups with the same two groups of key VHA stakeholders. Stakeholders were VHA-enrolled Veterans with medical chart evidence of long-term benzodiazepine use and national VHA leaders with expertise in setting VHA policy for prescription benzodiazepine use and developing electronically-delivered educational tools for Veterans. Qualitative data collected from each round of focus groups focused on emerging themes and feedback and recommendations on the intervention materials.

Results:

Themes that emerged from the initial focus groups included Veterans’ anxiety about self-tapering without medication and prior negative experiences attempting to self-taper without support. Participants also provided feedback on the protocol’s “look and feel”, educational materials, non medication help and support options for managing sleep and anxiety and the medication self-taper schedule. For example, feedback from policy leaders included listing, on the cover page, the mostly commonly prescribed benzodiazepines (within VHA) to ensure Veterans were aware of which medications qualify for self-taper using the EMPOWER-ED protocol. Both groups of stakeholders identified the importance of having access to supportive resources to help manage sleep difficulties and anxiety in the absence of taking benzodiazepines. Both groups also emphasized the importance of ensuring the self-taper could be personalized and that taper instructions, including amount of medication to be consumed each day, were clear. Policy leaders emphasized the importance of encouraging Veterans to notify their provider of their decision to taper to help facilitate provider assistance, if needed, in the taper process and help prevent the potential “stockpiling” of benzodiazepines.

Conclusions:

EMPOWER-ED is the first direct-to-patient electronically-delivered protocol designed to help US military Veterans, with evidence of long-term benzodiazepine use, self-taper their medication. We used the ADDIE framework to guide the successful adaption of the original EMPOWER booklet for use with this population and for electronic delivery (i.e., EMPOWER-ED). The next step in this line of research is to test EMPOWER-ED in a randomized controlled trial.