Mokhar Aliaksandra, Topp Janine, Härter Martin, Schulz Holger, Kuhn Silke, Verthein Uwe, Dirmaier Jörg
Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
PeerJ. 2018 Oct 8;6:e5535. doi: 10.7717/peerj.5535. eCollection 2018.
Benzodiazepines (BZDs) and z-drugs are effective drugs, but they are prescribed excessively worldwide. International guidelines recommend a maximum treatment duration of 4 weeks. Although these drugs are effective in the short-term, long-term BZD therapy is associated with considerable adverse effects, the development of tolerance and, finally, addiction. However, there are different interventions in terms of patient-centered care that aim to reduce the use of BZDs and z-drugs as well as assist health care professionals (HCPs) in preventing the inappropriate prescription of BZDs.
The aim of this systematic review was to identify interventions that promote patient-centered treatments for inappropriate BZD and z-drug use and to analyze their effectiveness in reducing the inappropriate use of these drugs.
To identify relevant studies, the PubMed, EMBASE, PsycINFO, Psyndex, and Cochrane Library databases were searched. Studies with controlled designs focusing on adult patients were included. Trials with chronically or mentally ill patients were excluded if long-term BZD and z-drug use was indicated. Study extraction was performed based on the Cochrane Form for study extraction. To assess the quality of the studies, we used a tool based on the Cochrane Collaboration's tool for assessing the risk of bias in randomized trials.
We identified 7,068 studies and selected 20 for systematic review. Nine interventions focused on patients, nine on HCPs, and two on both patients and HCPs. Intervention types ranged from simple to multifaceted. Patient-centered interventions that provided patient information effectively increased the appropriate use of BZDs. The educational approaches for HCPs that aimed to achieve appropriate prescription reported inconsistent results. The methods that combined informing patients and HCPs led to a significant reduction in BZD use.
This is the first review of studies focused on patient-centered approaches to reducing the inappropriate prescription and use of BZDs and z-drugs. The patient-centered dimension of patient information was responsible for a decrease in BZD and z-drug consumption. Further, in some studies, the patient-centered dimensions responsible for reducing the prescription and use of BZDs and z-drugs were the clinician's essential characteristics and clinician-patient communication.
苯二氮䓬类药物（BZDs）和非苯二氮䓬类助眠药物是有效的药物，但在全球范围内都存在过度处方的情况。国际指南建议最大治疗时长为4周。尽管这些药物在短期内有效，但长期使用BZD治疗会带来相当多的不良反应、产生耐受性并最终导致成瘾。然而，在以患者为中心的护理方面有不同的干预措施，旨在减少BZDs和非苯二氮䓬类助眠药物的使用，并协助医护人员（HCPs）防止不适当的BZD处方。
本系统评价的目的是确定促进以患者为中心治疗不适当使用BZD和非苯二氮䓬类助眠药物的干预措施，并分析其在减少这些药物不适当使用方面的有效性。
为了确定相关研究，检索了PubMed、EMBASE、PsycINFO、Psyndex和Cochrane图书馆数据库。纳入以成年患者为重点的对照设计研究。如果表明存在长期使用BZD和非苯二氮䓬类助眠药物的情况，则排除患有慢性病或精神疾病患者的试验。基于Cochrane研究提取表进行研究提取。为了评估研究质量，我们使用了一种基于Cochrane协作网用于评估随机试验偏倚风险的工具。
我们识别出7068项研究，并选择了20项进行系统评价。9项干预措施侧重于患者，9项侧重于医护人员，2项同时侧重于患者和医护人员。干预类型从简单到多方面不等。有效提供患者信息的以患者为中心的干预措施有效增加了BZDs的合理使用。旨在实现适当处方的针对医护人员的教育方法报告的结果不一致。将告知患者和医护人员相结合的方法导致BZD使用显著减少。
这是首次对专注于以患者为中心方法减少BZD和非苯二氮䓬类助眠药物不适当处方和使用的研究进行的综述。患者信息的以患者为中心维度导致了BZD和非苯二氮䓬类助眠药物消费的减少。此外，在一些研究中，负责减少BZD处方和使用的以患者为中心维度是临床医生的基本特征和医患沟通。
