Introduction: Benzodiazepines are widely prescribed in primary care to treat conditions such as insomnia, anxiety and chronic back pain. Despite guidance stating that they should only be used short-term in the UK and elsewhere, numerous studies have shown that these drugs are being prescribed for extended periods. This has led patients, policymakers and researchers to question why this is the case, what influences a clinician’s decision whether or not to initiate, continue or withdraw a benzodiazepine prescription and how inappropriate prescribing might be addressed. We aimed to explore GPs’ experiences and perceptions of benzodiazepine prescribing by conducting a meta-synthesis of qualitative studies to develop an explanatory framework of processes underlying benzodiazepine prescribing.
Methods: A systematic review of the literature was conducted to identify studies using qualitative methods which examined GPs’ experiences of prescribing benzodiazepines in a primary care setting. We included studies published in Western settings in a European language, between January 1990 and August 2011. Studies were critically appraised using the Critical Appraisal Skills Programme Checklist (CASP). A thematic synthesis approach was used to synthesise findings.
Results: A total of eight studies were included in the meta-synthesis. Analysis produced an explanatory framework detailing factors underlying benzodiazepine prescribing. This revealed that benzodiazepine prescribing is viewed as a complex task, and prescribing decisions are influenced by interaction between the following: the context within which benzodiazepine prescribing is taking place, the changing role and responsibility of GPs, variation in GPs’ attitudes towards benzodiazepines, a perceived lack of alternative treatment options, GPs’ perception of patient expectations, and the relationship between GPs and patients.
Conclusion: Our findings help to explain reasons for prescribing and define key recommendations for improving adherence to clinical guidelines advocating short-term use of benzodiazepines including: education and training of professionals on benzodiazepine prescribing and withdrawal, improved communication with patients, and an increase in the availability of alternative treatment options
