title: GPs' attitudes to benzodiazepine and 'Z-drug' prescribing: a barrier to implementation of evidence and guidance on hypnotics.
abstract: Zaleplon, zolpidem, and zopiclone ('Z-drugs') prescribing is gradually rising in the UK, while that of benzodiazepine hypnotics is falling. This situation is contrary to current evidence and guidance on hypnotic prescribing. The aim of this study was to determine and compare primary care physicians' perceptions of benefits and risks of benzodiazepine and Z-drug use, and physicians' prescribing behaviour in relation to hypnotics using a cross-sectional survey. In 2005 a self-administered postal questionnaire was sent to all GPs in West Lincolnshire Primary Care Trust. The questionnaire investigated perceptions of benefits and disadvantages of benzodiazepines and Z-drugs. Of the 107 questionnaires sent to GPs, 84 (78.5%) analysable responses were received. Responders believed that Z-drugs were more effective than benzodiazepines in terms of patients feeling rested on waking (P<0.001), daytime functioning (P<0.001), and total sleep time (P = 0.03). Z-drugs were also thought to be safer in terms of tolerance (P<0.001), addiction (P<0.001), dependence (P<0.001), daytime sleepiness (P<0.001), and road traffic accidents (P = 0.018), and were thought to be safer for older people (P<0.001). There were significant differences between GPs' perceptions of the relative benefits and risk of Z-drugs compared with benzodiazepines. The majority of practitioners attributed greater efficacy and lower side effects to Z-drugs. GPs' beliefs about effectiveness and safety are not determined by current evidence or national (NICE) guidance which may explain the increase in Z-drug prescribing relative to benzodiazepine prescribing.
authors.affiliation: School of Health and Social Care, University of Lincoln, Lincoln. nsiriwardena@lincoln.ac.uk
authors.forename: A Niroshan
authors.initials: AN
authors.lastname: Siriwardena
authors.forename: Zubair
authors.initials: Z
authors.lastname: Qureshi
authors.forename: Steve
authors.initials: S
authors.lastname: Gibson
authors.forename: Sarah
authors.initials: S
authors.lastname: Collier
authors.forename: Martin
authors.initials: M
authors.lastname: Latham
mesh_terms: D000081:Acetamides / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D053961:Azabicyclo Compounds; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004739:England; D005194:Family Practice; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000009:adverse effects / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011725:Pyridines / Q000009:adverse effects / Q000627:therapeutic use; D011743:Pyrimidines / Q000009:adverse effects / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D000077334:Zolpidem
chemical_list: D000081:Acetamides; D053961:Azabicyclo Compounds; D006993:Hypnotics and Sedatives; D010879:Piperazines; D011725:Pyridines; D011743:Pyrimidines; C515050:zopiclone; D001569:Benzodiazepines; D000077334:Zolpidem; C085665:zaleplon