2.1 Design
This qualitative study is part of an ongoing comprehensive project
examining the process of improving the delivery of evidence-based PTSD
care. This early work using grounded theory
methodology15 explored prescribing clinicians’
perceptions of adherence to the CPG recommendation regarding prescribing
of benzodiazepines to patients with PTSD through analysis of interviews
with primary care (PC) and mental health (MH) clinicians. Our primary
aims were to identify facilitators and barriers to PTSD guideline
adherence regarding benzodiazepine prescribing to aid in the development
of supportive strategies to de-implement this practice and improve the
care of patients at increased risk of harms.
2.2 Participants and setting
To recruit participants, we selected VA Medical Centers based on
hospital-level benzodiazepine data for patients with PTSD in fiscal
years 1999- 2009 based on our larger work.5 We grouped
all VA medical centers based on the degree of change in benzodiazepine
prescribing rates in context to their initial frequency of prescribing
into categories. Within each category 3 facilities were selected,
considering geographic variance and number of veterans with PTSD
treated. We had previously shown that rural patients treated at VA
facilities had an increased likelihood of receiving
benzodiazepines,16 so we selected at least one
hospital in each group that was considered rural. We also noted
geographic variation in prescribing benzodiazepines, so we selected
hospitals to represent specific geographic regions. In total 12 VA
Medical Centers and 2 smaller rural Community Based Outpatient Clinics
were selected for inclusion in the study. Providers from 1 hospital did
not respond to recruitment emails, resulting in 13 hospitals in the
final sample. We asked MH leadership from selected hospitals to
recommend the names of prescribing clinicians who treat PTSD in their
general mental health (MH) and primary care (PC) clinics. We then
randomly selected clinicians (1 from MH and 1 PC) from each hospital to
participate. In total, we contacted 42 participants by email to recruit
for participation, 8 failed to respond and 8 declined given time
constraints, resulting in a total of 26 clinicians for a 68%
participation rate.