Clinical Decision Making Regarding Benzodiazepine Use in PTSD Treatment

i. Rationale, Aims and Objectives: Despite guideline recommendations against their use, clinicians prescribe benzodiazepines for various symptoms to patients with posttraumatic stress disorder (PTSD). Clinicians’ reasons in making these decisions are not fully understood. This qualitative study sought to characterize factors identified by prescribing clinicians in clinical decision making in PTSD regarding the use of benzodiazepines. ii. Methods: The descriptive study involved semi-structured interviews with 26 prescribing clinicians across thirteen VA medical centers. Our overall aim in the study was to explore clinicians’ benzodiazepine practices in veterans with a PTSD diagnosis. We audio-recorded, transcribed, and analyzed the interviews using grounded theory methodology. iii. Results: Facilitators and barriers that contribute to benzodiazepine prescribing to veterans with PTSD included organizational, provider, and patient aspects. Most providers interviewed indicated that they inherited patients already on these medications initiated by other clinicians. These providers, as well as others interviewed, voiced concerns that tapering benzodiazepines may cause more harm than the risks of maintenance, particularly in older patients. Clinicians who noted consistent treatment practices among their hospital colleagues found it easier to decrease both new and maintenance benzodiazepine prescribing. iv. Conclusions: Patients with PTSD at increased risk of harms, such as older patients, are still receiving benzodiazepines suggesting that innovative solutions are now needed to decrease use. Specific protocols for inherited patient caseloads, increased dissemination of effective psychotherapies for symptoms such as insomnia and anxiety and the use of direct to consumer educational materials should help to foster needed culture change and increased evidence-based PTSD practice.

i. 基本原理、目的和目标：尽管指南不建议使用苯二氮䓬类药物，但临床医生仍会为创伤后应激障碍（PTSD）患者的各种症状开具此类药物。临床医生做出这些决定的原因尚未完全明确。本项定性研究旨在描述开具处方的临床医生在PTSD临床决策中关于苯二氮䓬类药物使用所确定的因素。 ii. 方法：这项描述性研究包括对13个退伍军人事务部医疗中心的26名开具处方的临床医生进行半结构化访谈。我们在研究中的总体目标是探究临床医生对诊断为PTSD的退伍军人使用苯二氮䓬类药物的情况。我们对访谈进行录音、转录，并使用扎根理论方法进行分析。 iii. 结果：影响为患有PTSD的退伍军人开具苯二氮䓬类药物的促进因素和障碍包括组织、医生和患者等方面。大多数接受访谈的医生表示，他们接手的患者已经在使用由其他临床医生开具的此类药物。这些医生以及其他接受访谈的人员都表示担心，减少苯二氮䓬类药物的剂量可能比维持用药的风险造成更大的伤害，尤其是对老年患者。注意到医院同事之间治疗方法一致的临床医生发现，减少新开苯二氮䓬类药物处方以及维持用药的处方更容易。 iv. 结论：面临更高伤害风险的PTSD患者，比如老年患者，仍然在使用苯二氮䓬类药物，这表明现在需要创新的解决方案来减少其使用。针对接手患者病例的特定方案、加大对失眠和焦虑等症状的有效心理疗法的推广以及使用直接面向消费者的教育材料，应该有助于促进所需的文化变革，并增加基于证据的PTSD治疗实践。