title: Physicians' perspectives on prescribing benzodiazepines for older adults: a qualitative study.
abstract: BACKGROUND
  There is a continued high prevalence of benzodiazepine use by older community-residing adults and of their continued prescription by practitioners, despite well known adverse effects and the availability of safer, effective alternatives.
  
  
  OBJECTIVE
  To understand factors influencing chronic use of benzodiazepines in older adults.
  
  
  METHODS
  Qualitative study, semistructured interviews with physicians.
  
  
  METHODS
  Thirty-three practicing primary care physicians around Philadelphia.
  
  
  METHODS
  Qualitative interviews were audiotaped, transcribed, and entered into a qualitative software program. A multidisciplinary team coded transcripts and developed themes.
  
  
  RESULTS
  Physicians generally endorsed benzodiazepines as effective treatment for anxiety, citing quick action and strong patient satisfaction. The use of benzodiazepines in older adults was not seen to be problematic because they did not show drug-seeking or escalating dose behavior suggesting addiction. Physicians minimized other risks of benzodiazepines and did not view monitoring or restricting renewal of prescriptions as an important clinical focus relative to higher-priority medical issues. Many physicians expressed skepticism about risks of continued use and considerable pessimism in the successful taper/discontinuation in older patients with long-term use and prior failed attempts. Physicians also anticipated patient resistance to any such efforts, including switching physicians.
  
  
  CONCLUSIONS
  Primary care physicians are averse to addressing the public health problem of benzodiazepine overuse in the elderly. Their attitudes generally conflict with practice guidelines and they complain of a lack of training in constructive strategies to address this problem. A 2-pronged effort should focus on increasing skill level and preventing new cases of benzodiazepine dependency through improved patient education and vigilant monitoring of prescription renewal.
authors.affiliation: Columbia University, New York, NY 10032, USA. jc2676@columbia.edu
authors.forename: Joan M
authors.initials: JM
authors.lastname: Cook
authors.forename: Randall
authors.initials: R
authors.lastname: Marshall
authors.forename: Christina
authors.initials: C
authors.lastname: Masci
authors.forename: James C
authors.initials: JC
authors.lastname: Coyne
mesh_terms: D000367:Age Factors; D000368:Aged; D001291:Attitude of Health Personnel; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use*; D011307:Drug Prescriptions; D005194:Family Practice / Q000379:methods; D005260:Female; D006801:Humans; D007407:Interviews as Topic / Q000379:methods; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D010820:Physicians; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D001569:Benzodiazepines