Brown R L, Brown R L, Saunders L A, Castelaz C A, Papasouliotis O
Department of Family Medicine, University of Wisconsin-Madison Medical School, USA.
J Gen Intern Med. 1997 Jan;12(1):44-52. doi: 10.1046/j.1525-1497.1997.12104.x.
To assess the effects of particular clinical cues on decisions about prescribing benzodiazepines.
A factorial survey based on social judgment theory.
A midwestern U.S. medical school.
Physicians (n = 115) recruited from the staff by invitation and interview.
Physicians indicated their level of agreement with prescribing a benzodiazepine for 24 hypothetical cases of nervousness and insomnia. The cases stemmed from the same scenario but varied systematically with regard to psychiatric diagnosis, recent ability to work, and long-term social stability. A fourth cue, called "health status," covertly depicted the presence or absence of three common alcohol-related medical problems. One fourth of the physicians agreed with prescribing for 15 or more cases, and 15% disagreed for all of them. Agreement was cumulative and least common for major depression, more common for adjustment disorder, and most common for generalized anxiety. Agreement with prescribing for cases with alcohol-related medical problems was 14% less than that for cases without them. Over half the physicians agreed with prescribing for 4 or more of the 12 cases with alcohol-related medical problems.
Prescribing decisions varied widely. Some physicians avoided benzodiazepines unnecessarily for some cases, while others agreed with prescribing for patients with a high probability of alcohol abuse. Blanket calls for more or less prescribing are overly simplistic; physicians should be able to recognize substance use disorders among anxious patients and make prescribing decisions based on relevant literature and clinical cues.
评估特定临床线索对开具苯二氮䓬类药物决策的影响。
基于社会判断理论的析因调查。
美国中西部一所医学院。
通过邀请和面谈从教职员工中招募的医生（n = 115）。
医生们表明了他们对于为24例假设的紧张和失眠病例开具苯二氮䓬类药物的同意程度。这些病例源于相同的情景，但在精神科诊断、近期工作能力和长期社会稳定性方面有系统性变化。第四个线索，称为“健康状况”，暗中描述了三种常见的与酒精相关的医学问题的有无。四分之一的医生同意为15个或更多病例开具药物，15%的医生对所有病例都不同意开具。同意的情况是累积性的，在重度抑郁症中最不常见，在适应障碍中较常见，在广泛性焦虑症中最常见。与没有酒精相关医学问题的病例相比，同意为有酒精相关医学问题的病例开具药物的比例低14%。超过一半的医生同意为12例有酒精相关医学问题的病例中的4个或更多病例开具药物。
处方决策差异很大。一些医生在某些情况下不必要地避免使用苯二氮䓬类药物，而另一些医生则同意为有酒精滥用高风险的患者开具药物。一概而论地要求增加或减少处方过于简单化；医生应该能够识别焦虑患者中的物质使用障碍，并根据相关文献和临床线索做出处方决策。
