Limitations
There are several limitations to our findings that we should note.
First, our intent was to describe barriers and facilitators participants
face in the use of benzodiazepines for PTSD, not to judge the
correctness of individual decisions. Some use of benzodiazepines may be
justified but the trend of continued prescribing in what might be
considered “high risk” subgroups such as older patients warrants
additional actions. Second, patients’ perspectives are critical. We had
to rely on provider feedback about patient level barriers and
facilitators, so patient voices should be reflected in future research.
Finally, our findings are most applicable to providers working with
military veterans who suffer from PTSD and are treated in the US VA
health care system. As we observed above, however, we believe there are
lessons learned from this work to help inform overall clinical decision
making, especially for large national health systems which share some
structural features with VA.
Conclusion
Due to the growing risks associated with benzodiazepines and their lack
of efficacy in the treatment of PTSD, it is worthwhile for the VA and
other healthcare systems to implement strategies that address the
barriers and facilitators to guideline concordant treatment identified
through this work. To do this, we must find ways, whenever possible,
both to encourage tapering among patients already on these drugs and
limit new prescriptions. Effective strategies to taper benzodiazepines
exist but are time-consuming and providers need support to implement
them.27 Hospital leadership needs to support culture
changes and dissemination of evidence-based practices to encourage
taking on this difficult task. VA has undertaken several steps to
improve PTSD treatment practices that include dissemination of
evidence-based psychotherapy, consultation for complex comorbid cases
through the PTSD Consultation Program, and funding PTSD pharmacotherapy
research to improve prescribing practices and discover new, safer
alternatives to benzodiazepines. It will be essential as we continue to
move forward to monitor the progress of these steps and the impact on
care, particularly in older patients at greatest risk and who are least
likely to be offered first-line psychotherapy treatments for
PTSD.17 Ultimately, the results of these efforts
should result in continued decreases in utilization of these medications
and improved access to effective treatment alternatives among all
patients with PTSD.