Abstract
BackgroundGiven the prevalence of long-term benzodiazepine (BZD) prescribing, increased monitoring through the implementation of prescription monitoring programmes (PMPs) may be the necessary impetus to promote BZD deprescribing. Despite evidence promoting the importance of patient-centred care, GPs have not been sufficiently supported to implement these principles through current deprescribing practice.AimTo investigate patients’ perception of their prescriber’s influence on ceasing BZD use, including their willingness to take their advice, and to understand how a patient’s stage of change influences the barriers and facilitators they perceive to discontinuing BZDs.Design and settingAn online survey and qualitative interviews with 22 long-term users of BZD (≥6 months), aged 18–69 years, recruited from the general population in Victoria, Australia.MethodTwo groups of users of BZD participated, one in the process of reducing their BZD and one not reducing, and were categorised according to their stage of change. Data underwent thematic analysis to identify barriers and facilitators to reducing BZDs both at the patient level and the prescriber level.ResultsBZD patients’ perceptions of the prescriber influence were characterised by prescribing behaviours, treatment approach, and attitude. Barriers and facilitators to reducing their BZD were mapped against their stage of change. Irrespective of their stage of change, participants reported they would be willing to try reducing their BZD if they trusted their prescriber.ConclusionThis study illustrates that, with a few key strategies at each step of the deprescribing conversation, GPs are well positioned to tackle the issue of long-term BZD use in a manner that is patient centred.
Highlights
Benzodiazepines (BZDs) are widely prescribed in the management of anxiety and insomnia, as well as for their muscle relaxant and anti-convulsant properties in conditions such as restless legs syndrome and epilepsy
Keywords benzodiazepines; z-drugs; general practice; patient-centred; deprescribing; guidelines. How this fits in The introduction of prescription monitoring programs (PMPs) has highlighted the need for increased support and guidance to ensure GPs improve on current deprescribing practice
This study revealed the importance of GPs understanding how to empower patients through patient-centred care, to foster a willingness to try reducing, to build motivation and promote confidence in the patients’ ability to reduce
Summary
Benzodiazepines (BZDs) are widely prescribed in the management of anxiety and insomnia, as well as for their muscle relaxant and anti-convulsant properties in conditions such as restless legs syndrome and epilepsy. ≤ four weeks) [1,2,3], as taken regularly beyond this time can lead to iatrogenic dependence, emotional blunting and depression, cognitive deficits, motor vehicle accidents, falls in older adults, and mortality [4,5,6,7,8]. Despite awareness of these harms, a significant disparity exists between evidence and practice as long-term BZD prescribing is commonly reported [9,10,11]. Despite evidence promoting the importance of patientcentred care, GPs have not been sufficiently supported to implement these principles through current deprescribing practice
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