Reconsidering Benzodiazepines and Z-Drug Prescriptions: Responsible Prescribing and Deprescribing

"Let's talk about sleep health": Patient perspectives on willingness to engage in psychological interventions for insomnia

BACKGROUND

Cognitive behavioural therapy for insomnia (CBT-I) is recommended as the first-line treatment yet remains underutilised in general practice. Understanding patient motivations and barriers to engaging in psychological interventions for insomnia is critical. Theoretical frameworks, such as the Theory of Planned Behaviour, are needed to identify variables related to intentions and behaviour change.

AIM

To explore key influences that motivate individuals' intention to engage with psychological interventions for insomnia.

DESIGN AND SETTING

An online survey and interviews with 20 community-dwelling participants with insomnia, aged 26-75 years.

METHOD

Guided by the Theory of Planned Behaviour, reflexive thematic analysis was used to identify factors influencing participants' intention to engage with psychological interventions for insomnia.

RESULTS

Participants reported positive attitudes towards psychological interventions for insomnia, stemming from negative beliefs about pharmacological sleep aids and the perceived benefits of a structured and evidence-based intervention. Important others positively influenced participants' intention to engage, however the GP influence was less consistent and often indirect. Participants believed in the efficacy of psychological interventions, but several barriers hampered their ability to benefit from them. Accessibility was identified as a key facilitator, whilst lack of knowledge and clear referral pathways were the main barriers impacting uptake.

CONCLUSION

This study highlights key factors influencing patients' intention to engage in psychological interventions for insomnia as well as opportunities for GPs to support uptake and engagement. Routine conversations about sleep health are essential to reduce the burden of untreated insomnia in the community, and active promotion of evidence-based psychological interventions are needed.

Role of the prescriber in supporting patients to discontinue benzodiazepines: a qualitative study

BACKGROUND

Given the prevalence of long-term benzodiazepine (BZD) prescribing, increased monitoring through the implementation of prescription monitoring programmes (PMPs) may be the necessary impetus to promote BZD deprescribing. Despite evidence promoting the importance of patient-centred care, GPs have not been sufficiently supported to implement these principles through current deprescribing practice.

AIM

To investigate patients' perception of their prescriber's influence on ceasing BZD use, including their willingness to take their advice, and to understand how a patient's stage of change influences the barriers and facilitators they perceive to discontinuing BZDs.

DESIGN AND SETTING

An online survey and qualitative interviews with 22 long-term users of BZD (≥6 months), aged 18-69 years, recruited from the general population in Victoria, Australia.

METHOD

Two groups of users of BZD participated, one in the process of reducing their BZD and one not reducing, and were categorised according to their stage of change. Data underwent thematic analysis to identify barriers and facilitators to reducing BZDs both at the patient level and the prescriber level.

RESULTS

BZD patients' perceptions of the prescriber influence were characterised by prescribing behaviours, treatment approach, and attitude. Barriers and facilitators to reducing their BZD were mapped against their stage of change. Irrespective of their stage of change, participants reported they would be willing to try reducing their BZD if they trusted their prescriber.

CONCLUSION

This study illustrates that, with a few key strategies at each step of the deprescribing conversation, GPs are well positioned to tackle the issue of long-term BZD use in a manner that is patient centred.