Identifying barriers and enablers for benzodiazepine (de)prescription: a qualitative study with patients and healthcare professionals

Egileak

  • A. Marquina-Márquez Department of Sociology and Social Work. University of Valladolid. Valladolid. Spain.
  • A. Olry-de-Labry-Lima Andalusian School of Public Health (Spanish acronym EASP). Granada. Spain. http://orcid.org/0000-0001-5448-1370
  • C. Bermúdez-Tamayo Andalusian School of Public Health (Spanish acronym EASP). Granada. Spain. https://orcid.org/0000-0002-2964-6361
  • I. Ferrer López Seville Primary Care Pharmacy Clinical Management Unit. Sevilla. Spain.
  • J. Marcos-Marcos Department of Health Psychology. University of Alicante. Spain. https://orcid.org/0000-0002-7607-6672

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https://doi.org/10.23938/ASSN.1005

Gako-hitzak:

Prescription drugs, Benzodiazepines, Primary health care, Qualitative research, Spain

Laburpena

Background. There has been a steadily growing trend in prescribing benzodiazepines over last decade. Spain is one of the countries where this class of drugs is most extensively prescribed by primary healthcare physicians. The aim of this study is to identify factors that might be acting as barriers and enablers for benzodiazepine (de)prescription from patient and professional perspectives.

Methods. Qualitative study through semi-structured interviews with medical practitioners (n=17) and patients (n=27), and a nominal group with medical practitioners (n=19). Interviews were audio-recorded, transcribed and analyzed using thematic analysis.

Results. The analysis revealed key themes and was organized around barriers and enablers connected to three interrelated dimensions: the social and community context of prescription; the structure, organization and/or management of the health system, and the doctor-patient relationship. The excessive workload of professionals was widely cited as influencing over-prescription. (De)prescription of benzodiazepine was facilitated by encouraging the social prescription of health assets or developing strategies to therapeutic alliance processes and better doctor-patient communication.

Conclusion. Our findings suggest that there is a role for the salutogenic approach and the health asset model in the development of a more person-centred clinical care. This study considers the importance of encouraging the use of non-pharmacological methods and techniques in the health system and promoting the creation of multidisciplinary teams, therapeutic alliance processes and better doctor-patient communication by giving professionals training in psychosocial skills.

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##submission.authorBiographies##

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  1. Department of Sociology and Social Work. University of Valladolid. Valladolid. Spain.
  2. Applied Sociocultural Studies Research Group (SEJ208). University of Granada. Granada. Spain.

##submission.authorWithAffiliation##

1. Andalusian School of Public Health (Spanish acronym EASP). Granada. Spain.

2. Health Research Institute of Granada (ibs.GRANADA). Granada. Spain.

3. Biomedical Research Center Network of Epidemiology and Public Health (CIBERESP). Madrid. Spain.

##submission.authorWithAffiliation##

  1. Andalusian School of Public Health (Spanish acronym EASP). Granada. Spain.
  2. Health Research Institute of Granada (ibs.GRANADA). Granada. Spain.
  3. Biomedical Research Center Network of Epidemiology and Public Health (CIBERESP). Madrid. Spain.

Erreferentziak

British Medical Association and Royal Pharmaceutical Society. British National Formulary (BNF). 65th ed. London: The Pharmaceutical Press, 2013.

Medicines and Healthcare products Regulatory Agency. UK Government. Guidance E-learning modules: medicines, 5: Benzodiazepines (April 2013). https://www.gov.uk/government/publications/e-learning-modules-medicines-and-medical-devices/e-learning-modules-medicines-and-medical-devices

GUSTAVSEN I, BRAMNESS JG, SKURTVEIT S, ENGELAND A, NEUTEL I, MØRLAND J. Road traffic accident risk related to prescriptions of the hypnotics zopiclone, zolpidem, flunitrazepam and nitrazepam. Sleep Med 2008; 9: 818–822. https://doi.org/10.1016/j.sleep.2007.11.011

OBIORA E, HUBBARD R, SANDERS R, MYLES PR. The impact of benzodiazepines on occurrence of pneumonia and mortality from pneumonia: a nested case-control and survival analysis in a population-based cohort. Thorax 2013; 68: 163-170. https://doi.org/10.1136/thoraxjnl-2013-203211

KHONG TP, DE VRIES F, GOLDENBERG JSB, KLUNGEL OH, RONBISON NJ, IBÁÑEZ L, PETRI H. Potential impact of benzodiazepine use on the rate of hip fractures in five large European countries and the United States. Calcif Tissue Int 2013; 91: 24-31. https://doi.org/10.1007/s00223-012-9603-8

CHEN PL, LEE WJ, SUN WZ, OYANG YJ, FUH JL. Risk of dementia in patients with insomnia and long-term use of hypnotics: a population-based retrospective cohort study. PLoS ONE 2012; 7: e49113. https://doi.org/10.1371/journal.pone.0049113

GLASS J, LANCTT KL, HERRMANN N, SPROULE BA, BUSTO UE. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. J Law Med 2005. https://doi.org/10.1136/bmj.38623.768588.47

BILLIOTI S, MORIDE Y, DUCRUET T, KURTH T, VERDOUX H, TOURNIER M et al. Benzodiazepine use and risk of Alzheimer’s disease: case-control study. BMJ 2014; 349: g5205. https://doi.org/10.1136/bmj.g5205

International Narcotics Control Board. Report 2020. https://www.incb.org/incb/en/publications/annual-reports/annual-report-2020.html

Organization for Economic Co-operation and Development. Health Statistics. Pharmaceutical consumption, 2017. http://stats.oecd.org/

Spanish Agency for Medicines and Health Products. Circular 3/2000: [Information that must appear in the data sheet of pharmaceutical specialties whose composition includes a benzodiazepine or analog (zolpidem, zopiclone), with the indication of anxiolytic and/or hypnotic]. Accessed January 25th 2022. https://www.sefh.es/alertas/alertas8.htm

European Monitoring Centre for Drugs and Drug Addiction. Impact of COVID-19 on patterns of drug use and drug related harms in Europe. https://www.emcdda.europa.eu/system/files/publications/13130/EMCDDA-Trendspotter-Covid-19-Wave-2_1.pdf

Agencia Española de Medicamentos y Productos Sanitarios. [Observatory of drug use. Use of anxiolytic and hypnotic drugs in Spain during the period 2010–2018]. https://www.aemps.gob.es/medicamentos-de-uso-humano/observatorio-de-uso-de-medicamentos/informes-ansioliticos-hipnoticos/

Ministerio de Salud. Gobierno de España. [2020-2021 Annual Report National Health System]. https://www.sanidad.gob.es/estadEstudios/estadisticas/sisInfSanSNS/tablasEstadisticas/InfAnSNS.htm

NOVAK SP, HAKANSSON A, MARTÍNEZ-RAGA J, REIMER J, KROTKI K, VARUGHESE S. Nonmedical use of prescription drugs in the European Union. BMC Psychiatry 2016; 16: 274. https://doi.org/10.1186/s12888-016-0909-3

United Nations Office on Drugs and Crime. COVID-19 and drugs: impact and outlook. World Drug Report, 2021. https://www.unodc.org/res/wdr2021/field/WDR21_Booklet_5.pdf

SÁNCHEZ-DÍAZ M, MARTÍN-CALVO ML, MATEOS-CAMPOS R. Trends in the use of anxiolytics in Castile and Leon, Spain, between 2015-2020: evaluating the impact of COVID-19. Int J Environ Res Public Health 2021; 5944. https://doi.org/10.3390/ijerph18115944

KHONG TP, de VRIES F, GOLDENBERG J, KLUNGEL O, ROBINSON N, IBÁÑEZ L, et al. Potential impact of benzodiazepine use on the rate of hip fractures in five large European countries and the United States. Calcif Tissue Int 2012; 19: 24-31. https://doi.org/10.1007/s00223-012-9603-8

TERÁN‐ÁLVAREZ L, GONZÁLEZ‐GARCÍA MJ, RIVERO‐PÉREZ AL, ALONSO‐LORENZOC JC, TARRAZO‐SUÁREZ JA. [Potentially inappropriate prescription according to the “STOPP” Criteria in heavily polymedicated elderly patients]. Semergen 2016; 42. https://doi.org/10.1016/j.semerg.2014.10.018

TOMMELEIN E, MEHUYS E, PETROVIC M, SOMERS A, COLIN P, BOUSSERY K. Potentially inappropriate prescribing in community-dwelling older people across Europe: a systematic literature review. Eur J Clin Pharmacol 2015; 71: 1415-1427, https://doi.org/10.1007/s00228-015-1954-4

SIRDIFIELD C, ANTHIERENS S, CREUPELANDT H. General practitioners' experiences and perceptions of benzodiazepine prescribing: systematic review and meta-synthesis. BMC Fam Pract 2013; 14: 191. https://doi.org/10.1186/1471-2296-14-191

FIXSEN AM, RIDGE D. Stories of hell and healing: internet users’ construction of benzodiazepine distress and withdrawal. Qual Health Res 2017; 17: 2030-2041. https://doi.org/10.1177/1049732317728053

FIXSEN AM. “I’m not waving, i’m drowning”: an autoethnographical exploration of biographical disruption and reconstruction during recovery from prescribed benzodiazepine use. Qual Health Res 2016; 26: 466-481. https://doi.org/10.1177/1049732315576496

WHITE JM, CORNISH F, KERR S. Front-line perspectives on 'joined-up' working relationships: a qualitative study of social prescribing in the west of Scotland. Health Soc Care Community 2017; 25: 194-203. https://doi.org/10.1111/hsc.12290

PÉREZ-WILSON P, MARCOS-MARCOS J, MORGAN A, ERIKSSON M, LINDSTRÖM B, ÁLVAREZ-DARDET C. ‘A synergy model of health’: an integration of salutogenesis and the health assets model. Health Promot Int 2021; 36: 884-894. https://doi.org/10.1093/heapro/daaa084

SMITH H, MILLER K, BARNETT N, OBOH L, JONES, E, DARCY C et al. Person-centred care including deprescribing for older people. Pharmacy (Basel) 2019; 7: 101. https://doi.org/10.3390/pharmacy7030101

PATTON MQ. Qualitative research and evaluation methods. 3rd ed. Thousand Oaks, CA: Sage Publications, 2002.

BRAUN V, CLARKE V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3: 77-101. https://www.tandfonline.com/doi/abs/10.1191/1478088706qp063oa

SAUNDERS B, SIM J, KINGSTONE T, BAKER S, WATERFIELD J, BARTLAM B, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant 2018; 52. https://doi.org/10.1007/s11135-017-0574-8

GOTTLIEB L, GARCIA K, WING H, MANCHANDA R Clinical interventions addressing nonmedical health determinants in Medicaid managed care. Am J Manag Care 2016; 22: 370-376.

PATEL KC, SPILSBURY P, SHUKLA R. Clinical contributions to addressing the social determinants of health. Clin Med 2010; 10: 130-133.

ANTHIERENS S, HABRAKEN H, PETROVIC M, CHRISTIAENS T. The lesser evil? Initiating a benzodiazepine prescription in general practice: a qualitative study on GPs' perspectives. Scand J Prim Health Care 2007; 25: 214-219 https://doi.org/10.1080/02813430701726335

GREEN AR, TUNG M, SEGAL JB. Older adults’ perceptions of the causes and consequences of healthcare overuse: a qualitative study. J Gen Intern Med 2018; 33: 892-897. https://doi.org/10.1007/s11606-017-4264-y

SIRDIFIELD C, CHIPCHASE SY, OWEN S, SIRIWARDENA AN. A systematic review and meta-synthesis of patients' experiences and perceptions of seeking and using benzodiazepines and z-drugs: towards safer prescribing. Patient 2017; 10: 1-15. https://doi.org/10.1007/s40271-016-0182-z

VAN BORTEL T, DARSHANA N, MORGAN M, MARTIN S. Health assets in a global context: a systematic review of the literature. BMJ Open 2019; 9: e023810. http://dx.doi.org/10.1136/bmjopen-2018-023810

LAWLESS A, FREEMAN T, BENTLEY M, BAUM F, JOLLEY G. Developing a good practice model to evaluate the effectiveness of comprehensive primary health care in local communities. BMC Fam Pract 2014; 15: 15-99. https://doi.org/10.1186/1471-2296-15-99

HREHOVÁ L, MEZIAN K. Non-pharmacologic treatment of insomnia in primary care settings. Int J Clin Pract 2021; 8: e14084 https://doi.org/10.1111/ijcp.14084

OLRY de LABRY-LIMA A, MARCOS-MARCOS J, MARQUINA-MARQUEZ A, et al., Evidence for deprescription in primary care through an umbrella review. BMC Family Practice 2020; 21: 100. https://doi.org/10.1186/s12875-020-01166-1

VICENS C, BEJARANO F, SEMPERE E, et al. Comparative efficacy of two interventions to discontinue long-term benzodiazepine use: cluster randomised controlled trial in primary care. Br J Psychiatry 2014; 204: 471–479. https://doi.org/10.1192/bjp.bp.113.134650

DARKER CD, SWEENEY BP, BARRY JM, FARRELL MF, DONNELLY-SWIFT E. Psychosocial interventions for benzodiazepine harmful use, abuse or dependence. Cochrane Database Syst Rev 2015; 5: CD009652. https://doi.org/10.1002/14651858.CD009652.pub2

FAIRBURN CG, ALLEN E, BAILEY-STRAEBLER S, O'CONNOR ME, Cooper Z. Scaling up psychological treatments: a countrywide test of the online training of therapists. J Med Internet Res 2017; 19: e214. https://doi.org/10.2196/jmir.7864

CHAN L, MACKINTOSH J, DOBBINS M. How the “Understanding Research Evidence” web-based video series from the National Collaborating Centre for Methods and Tools contributes to public health capacity to practice evidence-informed decision making: mixed-methods evaluation. J Med Internet Res 2017; 19: e286. https://doi.org/10.2196/jmir.6958

MURPHY R, HUTTON P. Practitioner Review: Therapist variability, patient-reported therapeutic alliance, and clinical outcomes in adolescents undergoing mental health treatment –a systematic review and meta-analysis. J. Child Psychol. Psychiatry 2018; 59: 5-19. https://doi.org/10.1111/jcpp.12767

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2022-08-17

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Marquina-Márquez, A., Olry-de-Labry-Lima, A., Bermúdez-Tamayo, C., Ferrer López, I., & Marcos-Marcos, J. (2022). Identifying barriers and enablers for benzodiazepine (de)prescription: a qualitative study with patients and healthcare professionals. Anales Del Sistema Sanitario De Navarra, 45(2), e1005. https://doi.org/10.23938/ASSN.1005

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bol: 45 zk: 2 (2022): mayo - agosto 2022

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