Physicians’ beliefs and attitudes about Benzodiazepines: a cross-sectional study

Abstract

Background In 2015, Portugal was the OECD country with the highest reported consumption of BZD. Physician’s perceptions and attitudes regarding BZD are main determinants of related prescription habits. This study aimed to characterize beliefs and attitudes of Portuguese physicians regarding the prescription, management challenges, benefits, risks and withdrawal effects of BZD. Methods A cross-sectional, observational study with online data collection through anonymous self-administered questionnaire. Physicians registered with the Portuguese Medical Association were invited to participate through direct e-mail message. Physicians were asked to give their opinion (using a 5-points Likert scale) regarding the prescription of BZD, their benefits and risks in the management of insomnia and anxiety, the possible adverse effects of chronic use and alternative non-pharmacologic approaches. Descriptive statistics were used and groups were compared through logistic regression. Results A total of 329 physicians participated in the study (56% family physicians). Mean age was 44.10 ± 15.2 years, with 19.03 ± 14.9 years of clinical experience. Fifty eight percent of participants were female. Physicians reported BZD’s negative impact on cognitive function (89%), association with road traffic accidents (88%) and falls (79%). Also, 58% shared the belief that chronic use is justified if the patient feels better and without adverse events. Although 68% reported to feel capable of helping patients to reduce or stop BZD, 55% recognized difficulties in motivating them. Compared to other medical specialists (altogether), family physicians were significantly more aware about the adverse effects of BZD and considered that chronic use may not be justified. Conversely, more family physicians expressed concerns about their skills to motivate patients engaging in withdrawal programs and to support them during the process. Conclusion Our results show that physicians’ awareness about risks of BZD chronic use is adequate though their attitudes and self-perceived skills towards promoting BZD withdrawal can be improved. Interventions in primary care are needed to capacitate physicians to better motivate patients for BZD withdrawal.

Role of the prescriber in supporting patients to discontinue benzodiazepines: a qualitative study

“…Despite acknowledging the need for better management of BZD harm (20,21), it appears GPs struggle with the competing demands of providing patients with comfort and relief, A c c e p t e d M a n u s c r i p t -B J G P -B J G P . 2 0 2 0 .…”

“…1 0 6 2 4 and the reality of deprescribing interventions that can be challenging and uncomfortable (20,22). As a result, a GP's attitude, skills, and knowledge regarding deprescribing influences the uptake and implementation of these interventions (21,23,24), where hesitation stems from insufficient experience and training rather than a lack of desire to address BZD harm (22,25). A recent review further emphasised the significance of this gap, showing that GP skills and knowledge were central components of patient-centred care, and the patient-centredness of deprescribing interventions underpinned their efficacy (26).…”

Combatting the misuse of benzodiazepines and related Z drugs in French general practice: a clinical review

“…Interventions in primary care are needed to enable physicians to better motivate patients for BZD withdrawal. 35 In Spain the analysis of the effectiveness of an intervention targeted to GPs to reduce BZD prescription and evaluate the implementation process has been published. 36…”

Raising Awareness Regarding Appropriate Benzodiazepine Use

“…3 In Europe, the level of consumption is high, and, Portugal has one of the highest levels of consumption of BZDs when compared with other European countries. 4 Long-term use of BZDs has been discouraged due to risks of addiction and its negative impact on multiple levels: i) increased risk of road-traffic accidents due to its influence on psychomotor abilities; ii) increased risk of falls and fractures and its association with cognitive deficits, dementia syndromes and delirium, in older patients; iii) its accessi-bility raises the risk of intoxications (sometimes voluntary) when BZDs are misused. 4 Even though guidelines recommended non-pharmacological interventions as first-line treatment for anxiety or sleep disorders, this is not always put into practice.…”

“…4 Long-term use of BZDs has been discouraged due to risks of addiction and its negative impact on multiple levels: i) increased risk of road-traffic accidents due to its influence on psychomotor abilities; ii) increased risk of falls and fractures and its association with cognitive deficits, dementia syndromes and delirium, in older patients; iii) its accessi-bility raises the risk of intoxications (sometimes voluntary) when BZDs are misused. 4 Even though guidelines recommended non-pharmacological interventions as first-line treatment for anxiety or sleep disorders, this is not always put into practice. This is due to lack of resources, especially in terms of psychological counselling and brief psycho-therapeutic interventions, and also a contemporary medicalization phenomenon of human suffering.…”