医生对苯二氮䓬类药物的信念和态度：一项横断面研究。
Physicians' beliefs and attitudes about Benzodiazepines: a cross-sectional study.
机构信息
Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal.
Administração Regional de Saúde de Lisboa e Vale do Tejo IP, Av. Estados Unidos da América 77, 1700-179, Lisbon, Portugal.
出版信息
BMC Fam Pract. 2019 May 25;20(1):71. doi: 10.1186/s12875-019-0965-0.
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.
背景
2015 年，葡萄牙是经合组织国家中报告 BZD 使用率最高的国家。医生对 BZD 的看法和态度是决定相关处方习惯的主要因素。本研究旨在描述葡萄牙医生对 BZD 的处方、管理挑战、益处、风险和戒断效应的信念和态度。
方法
这是一项横断面、观察性研究，通过匿名在线自填问卷进行数据收集。通过直接电子邮件向葡萄牙医师协会注册的医生发出邀请参加。要求医生对 BZD 的处方、在治疗失眠和焦虑症中的益处和风险、慢性使用的可能不良反应以及非药物替代方法发表意见（使用 5 分制 Likert 量表）。使用描述性统计方法，通过逻辑回归比较组间差异。
结果
共有 329 名医生参与了研究（56%为家庭医生）。平均年龄为 44.10±15.2 岁，临床经验 19.03±14.9 年。58%的参与者为女性。医生报告 BZD 对认知功能有负面影响（89%）、与道路交通碰撞（88%）和跌倒（79%）有关。此外，58%的人认为如果患者感觉更好且没有不良反应，慢性使用是合理的。尽管 68%的医生表示有能力帮助患者减少或停止 BZD，但 55%的人承认难以激发他们的动力。与其他医学专家（合计）相比，家庭医生对 BZD 的不良反应有更清晰的认识，认为慢性使用可能不合理。相反，更多的家庭医生对自己在启动戒断计划和在戒断过程中支持患者方面的技能表示担忧。
结论
我们的研究结果表明，医生对 BZD 慢性使用风险的认识是充分的，尽管他们对促进 BZD 戒断的态度和自我感知技能可以进一步提高。初级保健机构需要采取干预措施，使医生有能力更好地激励患者戒断 BZD。
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