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



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.



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.



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.



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.
Community and Health Research Unit, School of Health and Social Care, Bridge House, Brayford Campus, University of Lincoln, Lincoln, LN6 7TS, UK. csirdifield@lincoln.ac.uk.
Coral
C
Sirdifield
School of Psychology, Bridge House, Brayford Campus, University of Lincoln, Lincoln, LN6 7TS, UK.
Susan Y
SY
Chipchase
College of Social Science, Brayford Campus, University of Lincoln, Lincoln, LN6 7TS, UK.
Sara
S
Owen
Community and Health Research Unit, School of Health and Social Care, Bridge House, Brayford Campus, University of Lincoln, Lincoln, LN6 7TS, UK.
Aloysius Niroshan
AN
Siriwardena
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000188:drug therapy*; D001315:Australia; D001569:Benzodiazepines / Q000009:adverse effects* / Q000627:therapeutic use*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology*; D005060:Europe; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D036301:Qualitative Research; D012648:Self Care / Q000523:psychology; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy*
D001569:Benzodiazepines