Faculty of Health, School of Psychology, Deakin University, Geelong; benzodiazepine counsellor, Reconnexion, a service of EACH, Melbourne.
School of Psychology, Deakin University, Geelong.
Br J Gen Pract. 2021 Jun 24;71(708):e517-e527. doi: 10.3399/BJGP.2020.1062. Print 2021 Jul.
Given 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.
To 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.
An 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.
Two 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.
BZD 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.
This 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.
鉴于长期使用苯二氮䓬类药物（BZD）的普遍性，通过实施处方监测计划（PMP）加强监测，可能是推动 BZD 减药的必要动力。尽管有证据表明以患者为中心的护理的重要性，但全科医生在实施这些原则方面并没有得到足够的支持，无法将其应用于当前的减药实践中。
调查患者对其处方者停止使用 BZD 的影响的看法，包括他们是否愿意接受其建议，以及了解患者改变阶段如何影响他们认为中断 BZD 的障碍和促进因素。
对澳大利亚维多利亚州普通人群中 22 名长期使用 BZD（≥6 个月）的患者进行了在线调查和定性访谈，年龄在 18-69 岁之间。
参与研究的 BZD 用户分为两组，一组正在减少 BZD 的使用，另一组没有减少，并根据他们的改变阶段进行分类。数据进行了主题分析，以确定在患者和处方者层面上减少 BZD 的障碍和促进因素。
BZD 患者对处方者影响的看法特征是处方行为、治疗方法和态度。减少 BZD 的障碍和促进因素与他们的改变阶段相对应。无论他们处于哪个改变阶段，参与者报告说，如果他们信任他们的处方者，他们愿意尝试减少他们的 BZD 使用。
这项研究表明，只要在减药对话的每个步骤中采用一些关键策略，全科医生就能够以以患者为中心的方式解决长期使用 BZD 的问题。
