Palabras clave
Benzodiazepinas
Psicotrópicos
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Resumen
Objetivo: Investigar las opiniones de los médicos de atención primaria de salud (APS) sobre el uso crónico de benzodiazepinas (BZD), sus actitudes y las barreras para cambiar la práctica. Método: Cuestionario online aplicado a médicos de APS de una ciudad del nordeste. Resultados: De los 60 médicos de APS del municipio, respondió el 76,6%. 56,5% mujeres; 47,8% menores de 30 años y 63% no especialistas. Respecto a las opiniones, el 97,7% coincidió en que el consumo crónico de BZD es un problema de salud pública, perjudica la cognición y requiere información sobre la dependencia. El 45,6% considera que el insomnio/ansiedad no controlada causa más daño que las BZD. En cuanto a actitudes, las terapias preferidas fueron los ISRS (29%), cambios de estilo de vida (29%) y terapia psicosocial (24,6%). Las principales barreras: insistencia del paciente/cuidador (87,2%), falta de acceso a medidas no farmacológicas (80,4%), preocupación por el empeoramiento del estado del paciente (41,3%) y falta de tiempo (34,8%). Conclusión: El estudio destaca la presión de los pacientes, las restricciones en el acceso a alternativas terapéuticas y la gestión de la desprescripción como perpetuadores del uso de BZD.
Referencias
AGARWAL SD, LANDON BE. Patterns in Outpatient Benzodiazepine Prescribing in the United States. JAMA Network Open. 2019 Jan 25;2(1): e187399.
BALDAÇARA L, et al. Brazilian Psychiatric Association guidelines for the treatment of generalized anxiety disorder (GAD). Perspectives on Pharmacological and Psychotherapy approach. Braz J Psychiatry. 2024;46: e20233235.
BARDIN, L. Análise de Conteúdo. 3ª reimpressão da 1ª Edição de 2016. São Paulo: Edições 70, 2016.
BIGAL, AL, NAPPO, SA. Prescrição de benzodiazepínicos em Unidades Básicas de Saúde em uma comunidade com alta vulnerabilidade social. Saúde em Debate. 2024 Jun 1;48(141).
BRANDT J, et al. Prescribing and deprescribing guidance for benzodiazepine and benzodiazepine receptor agonist use in adults with depression, anxiety, and insomnia: an international scoping review. EClinical Medicine. 2024 Apr 1; 70:102507–7.
BUŽANČIĆ I, ORTNER HADŽIABDIĆ M. Development and Validation of Comprehensive Healthcare Providers’ Opinions, Preferences, and Attitudes towards Deprescribing (CHOPPED Questionnaire). Pharmacy. 2022 Jul 1;10(4):76.
BUŽANČIĆ I, ORTNER HADŽIABDIĆ M. Differences in Factors Influencing Deprescribing between Primary Care Providers: Cross-Sectional Study. International Journal of Environmental Research and Public Health. 2023 Mar 11;20(6):4957.
CAMARGO BM de O, et al. Uso de benzodiazepínicos na Atenção Primária à Saúde (APS). Revista de Medicina. 2023 Feb 6;102(esp):e–203871.
CAVALCANTE CCL, et al. Prevalência da dispensação de benzodiazepínicos em uma farmácia comunitária de Parnamirim-RN. Journal of Medicine and Health Promotion. 2016 v. 1, n. 2, p. 180–188.
DELAŠ AŽDAJIĆ M, et al. Prescription pattern and prevalence of benzodiazepine use among elderly patients. Asian Journal of Psychiatry. 2021 Jan; 55:102514.
DJATCHE L, et al. How confident are physicians in deprescribing for the elderly and what barriers prevent deprescribing? Journal of Clinical Pharmacy and Therapeutics. 2018 Apr 22;43(4):550–5.
FARIA JSS, et al. Benzodiazepínicos: revendo o uso para o desuso. Revista de Medicina. 2019 Nov 27;98(6):423–6.
FEGADOLLI C, et al. Uso e abuso de benzodiazepínicos na atenção primária à saúde: práticas profissionais no Brasil e em Cuba. Cadernos de Saúde Pública. 2019 Jul 4;35.
FONSECA AM, et al. Comparison between two household surveys on psychotropic drug use in Brazil: 2001 and 2004. Ciência & Saúde Coletiva. 2010 May;15(3):663–70.
GOLDSCHEN-OHM MP. Benzodiazepine Modulation of GABAA Receptors: A Mechanistic Perspective. Biomolecules. 2022 Nov 30;12(12):1784.
ISOMURA K, et al. Factors associated with long-term benzodiazepine and Z-drug use across the lifespan and 5-year temporal trajectories among incident users: a Swedish nationwide register-based study. Eur J Clin Pharmacol. 2023;79(8):1091-1105.
KATZMAN MA, et al. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry. 2014;14(Suppl 1): S1.
LEBLANC M, et al. Psychological and health-related quality of life factors associated with insomnia in a population-based sample. Journal of Psychosomatic Research. 2007 Aug;63(2):157–66.
LEE MH, et al. Trends in prescriptions for sedative-hypnotics among Korean adults: a nationwide prescription database study for 2011-2015. Social Psychiatry and Psychiatric Epidemiology. 2019 Apr 1;54(4):477–84.
LO SY, et al. Attitudes to Drug Use in Residential Aged Care Facilities: A Cross-Sectional Survey of Nurses and Care Staff. Drugs & Aging. 2021 Jun 25.
MADRUGA CS, et al. Prevalence of and pathways to benzodiazepine use in Brazil: the role of depression, sleep, and sedentary lifestyle. Brazilian Journal of Psychiatry. 2018 Oct 11; 41:44–50.
MAUST DT, et al. Benzodiazepine Use and Misuse Among Adults in the United States. Psychiatric Services. 2019 Feb;70(2):97–106.
MONDAL H, MONDAL S. Social desirability bias: A confounding factor to consider in survey by self-administered questionnaire. Indian Journal of Pharmacology. 2018;50(3):143.
NAPPO SA, et al. Prescription of anorectic and benzodiazepine drugs through notification B prescriptions in Natal, Rio Grande do Norte, Brazil. Brazilian Journal of Pharmaceutical Sciences. 2010 Jun;46(2):297–303.
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. Generalised anxiety disorder and panic disorder in adults: management Clinical guideline. 2020 Jun. Disponível em: https://www.nice.org.uk/guidance/cg113/resources/generalised-anxiety-disorder-and-panic-disorder-in-adults-management-pdf-35109387756997. Acessado em: 23 de julho de 2024.
NEVES IT, et al. Physicians’ beliefs and attitudes about Benzodiazepines: a cross-sectional study. BMC Family Practice. 2019 May 25;20(1).
OKUDA S, et al. Hypnotic prescription trends and patterns for the treatment of insomnia in Japan: analysis of a nationwide Japanese claims database. BMC Psychiatry. 2023 Apr 20;23(1).
RIBEIRO NF. Tratamento da Insônia em Atenção Primária à Saúde. Revista Brasileira de Medicina de Família e Comunidade. 2016 Dec 27;11(38):1–14.
RIEMANN D, et al. The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023. Journal of Sleep Research. 2023 Nov 28;32(6).
SANTIAGO COA, et al. Perfil do Consumo dos Benzodiazepínicos nos anos de 2019 e 2020 no Brasil e Regiões. Revista Ciência Plural. 2023 Aug 31;9(2):1–19.
SESAD - Secretaria Municipal de Saúde de Parnamirim [Internet]. sesad.parnamirim.rn.gov.br. Disponível em: http://sesad.parnamirim.rn.gov.br/unidades.html. Acessado em: 12 de novembro de 2023.
TAIPALE H, et al. Incidence of and Characteristics Associated with Long-term Benzodiazepine Use in Finland. JAMA Network Open. 2020 Oct 29;3(10): e2019029.
TAKESHIMA M, et al. Attitudes and Difficulties Associated with Benzodiazepine Discontinuation. International Journal of Environmental Research and Public Health. 2022 Nov 30;19(23):15990.
WELEFF J, et al. An Analysis of Benzodiazepine Prescribing to Primary Care Patients in a Large Healthcare System from 2019-2020. Journal of psychoactive drugs. 2023 Mar 20;1–12.
WICK JY. The history of benzodiazepines. The Consultant Pharmacist: The Journal of the American Society of Consultant Pharmacists. 2013 Sep 28;28(9):538–48.