Abstract

The problem: Benzodiazepines are known to have limited long-term therapeutic benefits, and to have adverse effects including addiction. Consequently, clinical guidelines advocate strictly short-term use. However, benzodiazepines continue to be prescribed for extended periods for conditions such as insomnia, anxiety and chronic back pain. Whilst research suggests that this may be due to factors such as patient demographics, GP attributes and general practice structures, clinicians’ experiences, beliefs and attitudes have also been shown to impact on their prescribing practices. Qualitative studies have the potential to better understand this clinical area by revealing the processes underlying prescribing practices.
The approach: We conducted a systematic review and meta-synthesis of qualitative research exploring GPs’ experiences and perceptions of benzodiazepine prescribing. Included studies needed to use both qualitative data and analysis, contain GP or nurse generated data on their experiences of prescribing benzodiazepines in Western primary care settings, and have been published between January 1990 and August 2011 in a European language. Findings from included studies were synthesised using the thematic synthesis approach in order to build an explanatory model of processes underlying prescribing practice.
Findings: Eight studies were included in the review. Prescribing decisions were complex, uncomfortable and demanding, particularly within the constraints of daily practice. Overall, GPs showed ambivalent attitudes towards benzodiazepine prescribing, and inconsistently applied management strategies for their use. Variation in prescribing practice was attributed to: the changing context within which GPs work; the role and responsibility of the GP; their attitudes towards benzodiazepines and other interventions; the perceived lack of alternative treatments; and GPs’ relationships with their patients and perceptions of their patients’ expectations. Different challenges are faced in managing initiation, continuation and withdrawal of benzodiazepines.
Consequences: The explanatory model produced from the themes identified within the metasynthesis can be used to propose ways to improve adherence to clinical guidelines which recommend short-term use of benzodiazepines only. Recommendations include: increasing education and training to change clinicians’ understanding and perceptions of both benzodiazepines and alternative treatments; increasing the availability of alternative treatments; encouraging clinicians to directly explore patients’ expectations with them to meet their expectations for clinical improvements.