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Clinical Decision Making Regarding Benzodiazepine Use in PTSD Treatment
  • +4
  • nancy bernardy,
  • Erin Barnett,
  • Brian Lund,
  • Bruce Alexander,
  • Louise Parker,
  • Aaron Jenkyn,
  • Matthew Friedman
nancy bernardy
White River Junction VA Medical Center
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Erin Barnett
Dartmouth College Geisel School of Medicine
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Brian Lund
Iowa City VA Medical Center
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Bruce Alexander
Iowa City VA Medical Center
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Louise Parker
University of Massachusetts Boston
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Aaron Jenkyn
White River Junction VA Medical Center
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Matthew Friedman
White River Junction VA Medical Center
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Abstract

i. Rationale, Aims and Objectives: Despite guideline recommendations against their use, clinicians prescribe benzodiazepines for various symptoms to patients with posttraumatic stress disorder (PTSD). Clinicians’ reasons in making these decisions are not fully understood. This qualitative study sought to characterize factors identified by prescribing clinicians in clinical decision making in PTSD regarding the use of benzodiazepines. ii. Methods: The descriptive study involved semi-structured interviews with 26 prescribing clinicians across thirteen VA medical centers. Our overall aim in the study was to explore clinicians’ benzodiazepine practices in veterans with a PTSD diagnosis. We audio-recorded, transcribed, and analyzed the interviews using grounded theory methodology. iii. Results: Facilitators and barriers that contribute to benzodiazepine prescribing to veterans with PTSD included organizational, provider, and patient aspects. Most providers interviewed indicated that they inherited patients already on these medications initiated by other clinicians. These providers, as well as others interviewed, voiced concerns that tapering benzodiazepines may cause more harm than the risks of maintenance, particularly in older patients. Clinicians who noted consistent treatment practices among their hospital colleagues found it easier to decrease both new and maintenance benzodiazepine prescribing. iv. Conclusions: Patients with PTSD at increased risk of harms, such as older patients, are still receiving benzodiazepines suggesting that innovative solutions are now needed to decrease use. Specific protocols for inherited patient caseloads, increased dissemination of effective psychotherapies for symptoms such as insomnia and anxiety and the use of direct to consumer educational materials should help to foster needed culture change and increased evidence-based PTSD practice.

Peer review status:UNDER REVIEW

27 Nov 2020Submitted to Journal of Evaluation in Clinical Practice
01 Dec 2020Assigned to Editor
01 Dec 2020Submission Checks Completed
02 Dec 2020Reviewer(s) Assigned
29 Dec 2020Review(s) Completed, Editorial Evaluation Pending