"It could potentially be dangerous... but nothing else has seemed to help me.": Patient and clinician perspectives on benzodiazepine use in opioid agonist treatment.
"It could potentially be dangerous... but nothing else has seemed to help me.": Patient and clinician perspectives on benzodiazepine use in opioid agonist treatment.
复制标题
DOI：
10.1016/j.jsat.2021.108455
复制
发表时间：
2021-12
影响因子：
3.9
通讯作者：
Drainoni ML
中科院分区：
文献类型：
--
作者：
Park TW;Sikov J;dellaBitta V;Saitz R;Walley AY;Drainoni ML
接受阿片类激动剂治疗 (OAT) 的患者使用苯二氮卓类药物会带来一个难题：苯二氮卓类药物会增加用药过量的风险，但可以治疗焦虑和失眠。如何在 OAT 患者中最好地平衡苯二氮卓类药物的风险和益处尚不清楚。使用定性方法，我们检查了患者使用苯二氮卓类药物的动机和对风险的理解，以及苯二氮卓类药物使用和处方发生的背景。我们对 26 名使用苯二氮卓类药物的 OAT 患者和 10 名 OAT 临床医生进行了半结构化访谈。参与者是从学术医疗中心的丁丙诺啡诊所和美沙酮阿片类药物治疗项目中通过有目的抽样招募的。研究团队审查了笔录并对 100% 的访谈进行了双重编码。数据分析结合了演绎法和归纳法。主要的新兴主题是：1) 患者关注苯二氮卓类药物的益处而非风险，2) 患者可以学习安全使用苯二氮卓类药物，3) 患者现在想要使用苯二氮卓类药物但将来停用，4) 临床医生和患者以不同方式权衡使用苯二氮卓类药物的风险和益处，5) 临床医生和患者的治疗目标存在差异，6) 临床医生在苯二氮卓类药物停药方面遇到困难。 OAT 患者和临床医生可以不同地权衡苯二氮卓类药物的风险和益处，从而导致治疗目标的不同。苯二氮卓类药物处方的风险效益分析可能取决于患者是否接受阿片类药物治疗。患者和临床医生之间的未来工作有必要确定如何更好地平衡患者和临床医生的优先事项，以便提供更安全的处方实践并保持患者参与护理。
Benzodiazepine use among patients receiving opioid agonist treatment (OAT) presents a conundrum: benzodiazepines increase overdose risk, yet can treat anxiety and insomnia. How best to balance the risks and benefits of benzodiazepines among OAT patients is unclear. Using qualitative methods, we examined patient motivations for benzodiazepine use and understanding of risks, and the context in which benzodiazepine use and prescribing occurs. We conducted semi-structured interviews with 26 OAT patients using benzodiazepines and 10 OAT clinicians. Participants were recruited from an office-based buprenorphine clinic at an academic medical center and a methadone opioid treatment program using purposive sampling. The study team reviewed transcripts and double-coded 100% of interviews. Data analysis combined both deductive and inductive methods. Major emergent themes were: 1) patients focus on benefits over risks of benzodiazepines, 2) patients can learn to use benzodiazepines safely, 3) patients want to use benzodiazepines now but discontinue in the future, 4) clinicians and patients weigh the risks and benefits of benzodiazepine use differently, 5) clinicians and patient have differences in treatment goals, and 6) clinicians struggle with benzodiazepine discontinuation. OAT patients and clinicians can weigh the risks and benefits of benzodiazepines differently leading to a difference in treatment goals. The risk-benefit analysis of benzodiazepine prescribing may depend on whether the patient is engaged in opioid treatment. Future work among patients and clinicians is warranted to determine how to better balance patient and clinician priorities in order to deliver safer prescribing practices and maintain patient engagement in care.
登录
查看更多内容
DOI：
10.1016/0749-5978(91)90020-t
发表时间：
1991-12-01
影响因子：
4.6
作者：
AJZEN, I
通讯作者：
AJZEN, I
影响因子：
2.9
作者：
Mah L;Upshur RE
通讯作者：
Upshur RE
影响因子：
2.2
作者：
Dybwad, TB;Kjolsrod, L;Laerum, E
通讯作者：
Laerum, E
影响因子：
4.2
作者：
Abrahamsson, Tove;Berge, Jonas;Hakansson, Anders
通讯作者：
Hakansson, Anders
影响因子：
4.4
作者：
Kim, Howard S.;McCarthy, Danielle M.;Lambert, Bruce L.
通讯作者：
Lambert, Bruce L.