What does qualitative research on patients' experiences tell us about how to support safer prescribing of BZDs and z-drugs?

Problem

Benzodiazepines and z-drugs are prescribed to manage insomnia, anxiety and pain. Long-term use can have adverse consequences, but nevertheless patients continue to receive these drugs contrary to medical guidelines

Approach

We conducted a systematic review and meta-synthesis to a) identify qualitative studies of patients’ experiences and perceptions of seeking and receiving benzodiazepines and z-drugs, and b) synthesise their findings focusing in particular on factors that perpetuate the use of these drugs and how we can support safer prescribing. We searched MEDLINE, CINAHL, Social Science Citation Index, Science Citation Index, PsycINFO, and AMED, for relevant qualitative studies published between January 2000 and April 2014 in a European language. Study quality was assessed using the Critical Appraisal Skills Programme qualitative checklist. Findings were synthesised using thematic synthesis

Findings

A total of nine studies were included in the review and we created seven analytical themes, structured around a patient journey: 1) patients’ negative perceptions of insomnia and its impact, 2) failed self-care strategies, 3) triggers to medical help-seeking, 4) attitudes towards treatment options and service provision, 5) varying patterns of use, 6) withdrawal, 7) reasons for initial or ongoing use

Consequences

Findings suggest that from a patient perspective, there are three key things that perpetuate the use of benzodiazepines and z-drugs. Firstly, patients feel psychologically dependent on them. Secondly, patients perceive there to be an absence of support for them to withdraw or use alternative treatments. Finally, patients either deny, dismiss, or are unaware of the potential side-effects. We could support safer prescribing by educating patients and healthcare professionals about the potential consequences of long-term use of these drugs, alternative treatments, and withdrawal strategies; making alternatives more readily available; and improving communication between patients and healthcare professionals on these issues