Lowering long-term use of benzodiazepine receptor agonists: a primary care perspective

Kristien Coteur, Sanne Peters, Pieter Jansen, Birgitte Schoenmakers, Marc Van Nuland

Keywords: primary care; benzodiazepines; insomnia; patients; general practitioners; pharmacists

Background:

Long-term use of benzodiazepine receptor agonists (BZRA) is a global health issue. Its complications jeopardise the personal health of BZRA users and come with substantial socio-economic costs. Nevertheless, it remains difficult to manage the decrease and stopping of BZRA use for insomnia in primary care. Motives to use BZRA in the long term remain unclear, and we currently have little direction on how to adequately support appropriate use.

Research questions:

Which factors contribute to long-term BZRA use for insomnia in primary care, from patients’, general practitioners', and pharmacists’ perspectives?

Method:

Qualitative research with in-depth semi-structured interviews, following a grounded theory approach, set in primary care in Belgium. Twenty-four participants were interviewed, including nine patients, six general practitioners, and nine pharmacists. Transcripts were analysed using the Framework Method. Thematic findings were interpreted in the context of the Theoretical Domains Framework.

Results:

We found a reflexive relation between views about hypnotic use at the level of society, healthcare, and patients. Six key messages captured factors that could contribute to lowering long-term BZRA use for insomnia in primary care: 1. societal beliefs as a game changer; 2. the opportunity of non-pharmacological treatment; 3. collaboration in primary care; 4. patient-centred goals; 5. informed consent; 6. self-management. Consistent with these factors, the participants discussed many ideas for interventions, which were mainly focused on the TDF domain of environmental context and resources.

Conclusions:

Long-term BZRA use for insomnia is a multifaceted health problem that is not adequately addressed at this time. The current social, and healthcare context are not empowering patients and professionals to lower long-term BZRA use for insomnia. Stakeholders have multiple ideas on how to turn the tide. Specifically, for primary care, all stakeholders reported the need for a non-medicalised relationship between the patient and general practitioner to improve prescribing rates.

Points for discussion:

Which community actions could contribute to a more empowering climate to lower BZRA use in your country?

Should you implement goal-oriented care for the treatment of insomnia in primary care?

How can we reduce the medicalisation of psychosomatic disorders in primary care?