Barriers to nonpharmacologic treatments for stress, anxiety, and insomnia: family physicians' attitudes toward benzodiazepine prescribing

Can Fam Physician. 2010 Nov;56(11):e398-406.

Abstract

Objective: To explore the attitudes of FPs toward benzodiazepine (BZD) prescribing and the perceived barriers to nonpharmacologic approaches to managing stress, anxiety, and insomnia.

Design: A questionnaire including 32 statements about treatment of insomnia, stress, and anxiety.

Setting: Local quality groups for FPs in Belgium.

Participants: A total of 948 Belgian FPs.

Main outcome measures: Barriers to using nonpharmacologic approaches in family practice.

Results: We identified 3 different groups of FPs according to their attitudes about BZD prescribing. A first relatively big group of FPs (39%) were not really concerned about the risks of BZD prescribing. Those in the second group (17%) were aware of the problems associated with BZDs, but did not perceive it to be their role to use nonpharmacologic approaches in family practice. Those in the third group (44%) were concerned about BZD prescribing and found it to be a "bad solution," but were faced with various barriers to applying nonpharmacologic approaches. Surprisingly, we found that nearly 97% of FPs thought that most people were eligible for nonpharmacologic approaches, but experienced implementation barriers at the level of the patient, the level of the FP, and the level of the health care system.

Conclusion: Using different education and behavioural-change strategies for different FP groups seems important. A large group of FPs does not find prescribing BZDs to be problematic. Sensitizing and alerting FPs to this issue remains very important.

OBJECTIF: Déterminer l’attitude de MF quant à la prescription de benzodiazépines (BZD) et leur opinion sur les facteurs qui font obstacle aux approches non pharmacologiques pour traiter le stress, l’anxiété et l’insomnie.

TYPE D’ÉTUDE: Un questionnaire de 32 items au sujet du traitement de l’insomnie, du stress et de l’anxiété.

CONTEXTE: Groupes locaux d’évaluation médicale pour les MF belges.

PARTICIPANTS: Un total de 948 MF belges.

PRINCIPAUX PARAMÈTRES À L’ÉTUDE: Obstacles à l’utilisation des approches non pharmacologiques en médecine familiale.

RÉSULTATS: Nous avons identifié 3 groupes de MF selon leur attitude quant à la prescription de BZD. Un groupe relativement important de MF (39 %) n’étaient pas vraiment inquiets des risques de prescrire des BZD. Un deuxième groupe (17 %) étaient au courant des dangers des BZD mais ne croyaient pas que c’était le rôle du MF d’utiliser les approches non pharmacologiques. Ceux du troisième groupe étaient réticents à prescrire des BZD et considéraient qu’il s’agissait d’une « mauvaise solution », mais ils rencontraient plusieurs obstacles dans l’utilisation des approches non pharmacologiques. Chose surprenante, près de 97 % des MF estimaient que la plupart des patients pouvaient bénéficier des approches non pharmacologiques, mais avaient rencontré des obstacles à leur utilisation aux niveaux du patient, du MF et du système de santé.

CONCLUSION: Il semblerait important d’utiliser des stratégies de formation et de modifications comportementales différentes pour différents groupes de MF. Un important groupe de MF ne considèrent pas la prescription de BZD problématique. Il demeure très important de sensibiliser et d’alerter les MF à ce sujet.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Anxiety Agents / therapeutic use*
  • Anxiety Disorders / drug therapy*
  • Anxiety Disorders / prevention & control
  • Attitude of Health Personnel
  • Belgium
  • Benzodiazepines / therapeutic use*
  • Cross-Sectional Studies
  • Drug Utilization
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care / standards*
  • Patient Acceptance of Health Care / psychology
  • Patient Acceptance of Health Care / statistics & numerical data
  • Physicians, Family / psychology*
  • Physicians, Family / statistics & numerical data
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Sleep Initiation and Maintenance Disorders / drug therapy*
  • Sleep Initiation and Maintenance Disorders / prevention & control
  • Stress, Psychological / drug therapy*
  • Stress, Psychological / prevention & control
  • Surveys and Questionnaires

Substances

  • Anti-Anxiety Agents
  • Benzodiazepines