Van Ngoc Pauline, Ceuterick Melissa, Belche Jean-Luc, Scholtes Beatrice
Research Unit of Primary Care and Health, Department of General Medicine, University of Liège, Liège, Belgium
Hedera, Department of Sociology, Ghent University, Ghent, Belgium.
BJGP Open. 2024 Apr 25;8(1). doi: 10.3399/BJGPO.2023.0034. Print 2024 Apr.
Benzodiazepines and Z-drugs (BZD/Z) are frequently prescribed for longer than recommended. Through their interactions with patients taking BZD/Z, primary care and mental health professionals play a key role in the management of this medication.
To explore how primary care and mental health care professionals set treatment goals with users of long-term BZD/Z.
DESIGN & SETTING: A qualitative study using semi-structured interviews with professionals from mental health, addiction care, and primary care practices in Belgium.
Semi-structured interviews were conducted, online and in person, with 24 professionals working in mental health and primary care. Inductive thematic content analysis was performed.
Seven themes were identified from the analysis. Professionals tended not to use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) standard to diagnose a BZD/Z substance use disorder. They described criteria based on their experience. They identified diverse types of patients that influence their choice of treatment goals. Professionals appeared to position themselves according to their own treatment goals for their patients, either by promoting the goal of abstinence or harm reduction. Some of them reported feeling trapped into continuing to prescribe and considered BZD/Z withdrawal to be difficult. Some were afraid to engage in a conversation that might break the bond of trust with the patient. Few professionals mentioned patient participation in the treatment goal setting. They asked for targeted withdrawal recommendations, perceiving the current recommendations to be too broad.
Whether primary care or mental health care professionals are more in favour of a total abstinence or a harm reduction approach to BZD/Z, professionals should be guided towards greater patient participation in setting and evaluating goals with patients taking BZD/Z.
苯二氮䓬类药物和Z类药物（BZD/Z）的处方开具时间常常超过推荐时长。通过与服用BZD/Z的患者互动，初级保健和心理健康专业人员在这类药物的管理中发挥着关键作用。
探讨初级保健和心理健康专业人员如何与长期使用BZD/Z的患者设定治疗目标。
一项定性研究，采用对比利时心理健康、成瘾护理和初级保健机构的专业人员进行半结构化访谈的方式。
对24名从事心理健康和初级保健工作的专业人员进行了线上和线下的半结构化访谈。进行了归纳性主题内容分析。
分析确定了七个主题。专业人员往往不使用《精神疾病诊断与统计手册》第五版（DSM-V）标准来诊断BZD/Z物质使用障碍。他们根据自身经验描述了标准。他们确定了影响其治疗目标选择的不同类型患者。专业人员似乎根据自己对患者的治疗目标来定位自己，要么倡导戒断目标，要么倡导减少伤害目标。他们中的一些人报告说感觉陷入了持续开药的困境，并认为BZD/Z戒断很困难。一些人害怕进行可能会破坏与患者信任关系的对话。很少有专业人员提到患者参与治疗目标设定。他们要求提供有针对性的戒断建议，认为当前的建议过于宽泛。
无论初级保健还是心理健康专业人员更倾向于对BZD/Z采取完全戒断还是减少伤害的方法，都应引导专业人员让患者更多地参与与服用BZD/Z患者设定和评估目标的过程。
