A Systematic Review and Meta-Synthesis of Patients’ Experiences and Perceptions of Seeking and Using Benzodiazepines and Z-Drugs: Towards Safer Prescribing

Abstract

Background

Benzodiazepines and Z-drugs are used to treat complaints like insomnia, anxiety and pain. These drugs are recommended for short-term use only, but many studies report long-term use, particularly in older people.

Objective

The aim of this study was to identify and synthesise qualitative studies exploring patients’ experiences and perceptions of receiving benzodiazepines and Z-drugs, and through this identify factors which perpetuate use of these drugs, and strategies for achieving safer prescribing.

Methods

A systematic search of six databases for qualitative studies exploring patients’ experiences and perceptions of primary care benzodiazepine and z-drug prescribing published between January 2000 and April 2014 in a European language, and conducted in Europe, the United States, Australia or New Zealand. Reference lists of included papers were also searched. Study quality was assessed using the Critical Appraisal Skills Programme qualitative checklist. Findings were synthesised using thematic synthesis.

Results

Nine papers were included and seven analytical themes were identified relating to patients’ experiences and perceptions and, within that, strategies for safer prescribing of benzodiazepines and Z-drugs: (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.

Conclusions

Inappropriate use and prescribing of benzodiazepines and Z-drugs is perpetuated by psychological dependence, absence of support and patients’ denial/lack of knowledge of side effects. Education strategies, increased availability of alternatives, and targeted extended dialogue with patients could support safer prescribing.

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Notes

  1. 1.

    By ‘healthcare professionals’, we mean a wide variety of roles including GPs, psychiatrists, psychologists, practice nurses, community pharmacists and other allied health professionals.

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Acknowledgements

Thank you to Rebecca Porter (School of Health and Social Care, University of Lincoln) for her support with data extraction for this project.

Author contributions

Sirdifield led the study and contributed to all stages of the analysis and write-up. Chipchase contributed to all stages of the analysis and write up. Owen read and commented on drafts of the paper and model, and proof read the final version. Siriwardena had the idea for this study, and has contributed to the design, conception, analysis and drafts of the paper (including final revisions).

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Correspondence to Coral Sirdifield.

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This study was funded by a University of Lincoln College Research Fund grant. There are no conflicts of interest for Sirdifield, Chipchase, Owen or Siriwardena.

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Sirdifield, C., Chipchase, S.Y., Owen, S. et al. A Systematic Review and Meta-Synthesis of Patients’ Experiences and Perceptions of Seeking and Using Benzodiazepines and Z-Drugs: Towards Safer Prescribing. Patient 10, 1–15 (2017). https://doi.org/10.1007/s40271-016-0182-z

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Keywords

  • Healthcare Professional
  • Cognitive Behavioural Therapy
  • Zolpidem
  • Zopiclone
  • Zaleplon