Cook Joan M, Marshall Randall, Masci Christina, Coyne James C
Columbia University, New York, NY 10032, USA.
J Gen Intern Med. 2007 Mar;22(3):303-7. doi: 10.1007/s11606-006-0021-3.
There is a continued high prevalence of benzodiazepine use by older community-residing adults and of their continued prescription by practitioners, despite well known adverse effects and the availability of safer, effective alternatives.
To understand factors influencing chronic use of benzodiazepines in older adults.
Qualitative study, semistructured interviews with physicians.
Thirty-three practicing primary care physicians around Philadelphia.
Qualitative interviews were audiotaped, transcribed, and entered into a qualitative software program. A multidisciplinary team coded transcripts and developed themes.
Physicians generally endorsed benzodiazepines as effective treatment for anxiety, citing quick action and strong patient satisfaction. The use of benzodiazepines in older adults was not seen to be problematic because they did not show drug-seeking or escalating dose behavior suggesting addiction. Physicians minimized other risks of benzodiazepines and did not view monitoring or restricting renewal of prescriptions as an important clinical focus relative to higher-priority medical issues. Many physicians expressed skepticism about risks of continued use and considerable pessimism in the successful taper/discontinuation in older patients with long-term use and prior failed attempts. Physicians also anticipated patient resistance to any such efforts, including switching physicians.
Primary care physicians are averse to addressing the public health problem of benzodiazepine overuse in the elderly. Their attitudes generally conflict with practice guidelines and they complain of a lack of training in constructive strategies to address this problem. A 2-pronged effort should focus on increasing skill level and preventing new cases of benzodiazepine dependency through improved patient education and vigilant monitoring of prescription renewal.
尽管苯二氮䓬类药物存在众所周知的不良反应，且有更安全、有效的替代药物，但社区居住的老年人中使用此类药物的比例持续居高不下，医生也持续开具此类药物的处方。
了解影响老年人长期使用苯二氮䓬类药物的因素。
定性研究，对医生进行半结构化访谈。
费城周边33名执业初级保健医生。
对定性访谈进行录音、转录，并录入定性软件程序。一个多学科团队对转录文本进行编码并确定主题。
医生普遍认可苯二氮䓬类药物是治疗焦虑的有效药物，称其起效快且患者满意度高。老年人使用苯二氮䓬类药物未被视为问题，因为他们未表现出寻求药物或增加剂量的行为，即未显示成瘾迹象。医生将苯二氮䓬类药物的其他风险降至最低，相对于更优先的医疗问题，他们不认为监测或限制处方续签是重要的临床关注点。许多医生对持续使用的风险表示怀疑，对于长期使用且之前尝试减量/停药失败的老年患者成功减量/停药相当悲观。医生还预计患者会抵制任何此类努力，包括更换医生。
初级保健医生不愿解决老年人苯二氮䓬类药物过度使用这一公共卫生问题。他们的态度通常与实践指南相冲突，且抱怨缺乏解决此问题的建设性策略方面的培训。应采取双管齐下的措施，重点是提高技能水平，并通过改善患者教育和对处方续签的严格监测来预防苯二氮䓬类药物依赖的新病例。
