Added: Adalberto Finn - Date: 29.07.2021 14:34 - Views: 39572 - Clicks: 7760
Try out PMC Labs and tell us what you think. Learn More. Chronic benzodiazepine BZD use is widespread and linked with adverse effects. There is consensus concerning the importance of initiating BZD as a crucial moment. Nevertheless specific research in this field is lacking.
Qualitative study with five focus groups analysed using a systematic content analysis. GPs reported that they are cautious in initiating BZD usage. At the same time, GPs feel overwhelmed by the psychosocial problems of their patients. They show empathy by prescribing. They feel in certain situations there are no other solutions and they experience BZDs as the lesser evil.
They admit to resorting to BZDs because of time restraint and lack of alternatives. GPs do not perceive the addictive nature of BZD consumption as a problem with first-time users. The main concern of GPs is to help the patient. GPs should be aware of the addictive nature of BZD even in low doses and a non-pharmacological approach should be seen as the best first approach.
Chronic benzodiazepine BZD use is a widespread phenomenon. GPs feel overwhelmed by psychosocial problems of patients and show empathy by prescribing. During the s and '70s, people felt that taking medication was a safe and justifiable way of coping with the stresses and strains of everyday life. BZDs comprise one of the most commonly taken psychotropic drugs,  even though GPs regard prescribing of BZDs as one of the most demanding and uncomfortable tasks in their clinical work because of the restrictive attitudes of both society and health authorities .
Prolonged use of BZDs is a widespread phenomenon in medical practice . There are the potential side effects of hypnotic drugs, evidence of long-term use contrary to d indications, and a lack of evidence distinguishing short-acting BZDs alprazolam, lorazepam, lormetazepam, temazepam and newer hypnotics, the so called Z-drugs zaleplon, zolpidem, and zopiclone  , . Among the risks of inappropriate BZD prescription are the development of physical and psychological dependence, withdrawal symptoms when discontinuing the treatment  ,  and particularly in the elderly cognitive impairment, falls, and consecutive hip fractures [9—11].
In a study by De las Cuevas et al. The best way to avoid dependence is by careful prescription and, where possible, by avoiding initial prescription and using non-pharmacological treatment strategies. It is therefore important to explore the reason why GPs prescribe a BZD to a patient for the very first time. To the best of our knowledge so far, there are no studies that look specifically at the views and motives of GPs concerning the initiation of BZDs, as most research articles talk about BZD prescribing behaviour in general  , [13—16] or about chronic usage [17—20].
We used a phenomenological qualitative approach as we were concerned with experiences and views of individuals . We contacted GP quality circles from four different regions by letter. Thirty-five out of 58 GPs agreed to participate in the study. The GPs willing to participate constituted five focus groups with a wide range of experience and knowledge. Each group comprised between six and eight GPs.
To facilitate the interviews and to ensure that the same issues were discussed in all of them, an interview guide with open-ended questions was compiled and piloted. An experienced moderator facilitated the group discussion by asking clarifying questions and each group session lasted approximately 1.
During the interviews, one member of the research team was present to observe the proceedings. The researcher who was present debriefed with the moderator and reviewed field notes after each session. All five focus-group discussions were audiotaped and transcribed verbatim. Data management was undertaken manually. Systematic content analysis  was performed by three interdisciplinary researchers psychologist, sociologist, and GP in the interests of reliability and reflexivity and to set aside any preconceptions .
Emerging themes were developed by repeated study of the transcripts and the attribution of codes to text segments. Rather than impose a framework a priori, this was allowed to evolve from the data. It was then gradually refined by grouping related  and analysing relationships between sub-themes in order to produce a descriptive phenomenological set of  , . Attention has been given to deviant case analysis . GPs mentioned that they were cautious when initiating a BZD prescription, especially when providing new prescriptions.
Patients were informed that they would only receive their prescription on a short-term basis:. We do not prescribe BZD any more for people who have constant anxieties. We prescribe BZD in acute situations and always within a time limit. Moderate use of BZD should be put into perspective, as there are some real advantages for the patient:. If you can take the pressure away and give the patient some rest, then at least after some time they will have the energy to tackle their problem, otherwise they will never get out of it.
GPs stated that dependence was not really a problem for first-time users. BZDs were seen as an efficient, cheap, and easy option that does not have too many side-effects:. Your own attitude towards and experience of the product definitely has an effect on prescribing. We, ourselves, take a lot of benzodiazepines. Followed by general agreement in the group R They empathize with the suffering of their individual patients and empathy is shown by giving a prescription. Sometimes GPs have to negotiate with the patient as well, to try and find a solution that suits both doctor and patient and sometimes this can result in conflicting views:.
The patient says: I do not want to become dependent for the rest of my life. But sometimes, you just have to prescribe a benzo to stabilize the patient. So we cannot just say we won't prescribe benzos anymore. If you do prescribe them a BZD, they are very grateful. They come back to you and they are so happy because they have finally managed to sleep. That is so important, it makes you feel good. GPs have difficulties with establishing boundaries on how far they can question their patients about their problems.
GPs find it easier to try and solve the problem by initiating a BZD prescription. GPs also feel uncertain how to deal with psychosocial problems, as a result of insufficient training:. Whether I want it or not but I haven't got the training for it. What do I do? I prescribe. A complex psychosocial situation is often the cause of the distress and the GP feels powerless in such situations. You have to think that if you were in their situation you would not know what to do either. In this situation this person needs a BZD to give him some support for the things that are unbearable. GPs expressed the view that there was an inverse relationship between time spent on consultation and the prescription of BZDs.
Prescribing BZDs was considered to take less time than convincing the patient of a non-pharmacological approach or actively providing counselling during the consultation. I do try and talk to my patients, but it takes time. It is so much easier just to prescribe than to listen and talk to them for three-quarters of an hour. It was perceived that there is limited access to psychological services in primary care. There just isn't an alternative. And yes, I do admit we do prescribe too quickly. Treatment options were thought to be influenced by socioeconomic status, gender, and age:.
We do not suggest counselling to the elderly. They don't know any psychologists and they have never been to one. Non-pharmacological alternatives were also viewed as much more expensive and less accessible for patients with limited financial resources. The perception of the GP towards non-pharmacological alternatives plays a role in whether or not to refer a patient:. I also have the feeling that a psychotherapist is a bit like a tape recorder. GPs looked mainly for alternatives within their medical sphere. A wide range of medication such as antidepressants or neuroleptics was seen as an alternative.
Other GPs were more inclined to use plant extracts because of a lower risk of dependence but at the same time they acknowledged a placebo effect:. Sometimes we give patients a phytotherapeutic agent. We give it because it looks like a pill.
So if it works for them, so much the better. We found that GPs feel overwhelmed by the psychosocial problems of their patients and show empathy by prescribing. The fact that patient demand was not an element that was mentioned for initiating prescription was striking; this is in contrast with studies on chronic use . BZDs are judged to be effective and beneficial by both patient and GPs without causing too many side effects. Similar findings were found in a recent British study .
These beliefs are based on personal experience and are not concordant with studies which have shown that BZDs have many side effects and tolerance appears very rapidly [7—11]. GPs are aware of the potential addictive nature.
They do not, however, perceive it as a problem when initiating treatment using therapeutic doses. These findings agree with a study by Boixet et al. Problems with BZD initiation also depend on package size, explanation given, and follow-up consultation. However, we have shown in a study that little or no information is given to patients when initiating treatment . Research has shown that non-pharmacological alternatives are not routinely offered to patients  , although such an approach has been demonstrated to be effective  , thus the decision to prescribe medication is seen as the most effective way to help a patient .
Our findings could be context specific for a fee-for-service system. Our findings might also reflect the fact that doctors perceive themselves as individual players in primary healthcare and find it difficult to overcome certain barriers to involve social workers or psychotherapists.Getting prescribed benzos
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