Teaching Young GPs to Cope with Psychosocial Consultations Without Prescribing: a Durable Impact of an E-module on Determinants of Benzodiazepines Prescribing

Overview

Journal BMC Med Educ

Publisher Biomed Central

Specialty Medical Education

Date 2017 Dec 21

PMID 29258496

Citations 8

Authors

Hanne Creupelandt

Sibyl Anthierens

Hilde Habraken

Tom Declercq

Coral Sirdifield

Aloysius Niroshan Siriwardena

Thierry Christiaens

Affiliations

Soon will be listed here.

Abstract

Background: Despite guidelines and campaigns to change prescribing behavior, General Practitioners (GPs) continue to overprescribe benzodiazepines (BZDs). New approaches to improve prescribing are needed. Using behavior change techniques and tailoring interventions to user characteristics are vital to promote behavior change. This study evaluated the impact of an e-module on factors known to determine BZD prescribing practice.

Methods: A tailored e-module that focuses on avoiding initial BZD prescriptions (and using psychological interventions as an alternative) was developed and offered to GPs in vocational training. Three self-report assessments took place: at baseline, immediately after the module (short term) and at least six months after completion (long term). Assessed determinants include GPs' attitudes concerning treatment options, perceptions of the patient and self-efficacy beliefs. Readiness to adhere to prescribing guidelines was evaluated through assessing motivation, self-efficacy and implementability of non-pharmacological interventions. Changes in determinants were analyzed using the Wilcoxon signed-rank test. Changes in readiness to adhere to guidelines was analyzed using the nonparametric McNemar Bowker test.

Results: A desirable, significant and durable impact on determinants of BZD prescribing was observed. GPs (n = 121) underwent desirable changes in their attitudes, perceptions and self-efficacy beliefs and these changes remained significant months after the intervention. Barriers to using a non-pharmacological approach often cited in literature remained absent and were not highlighted by the intervention. Furthermore a significant impact on GPs' readiness to adhere to guidelines was observed. Participants reported change in their ability to cope with psychosocial consultations and to have tried using non-pharmacological interventions.

Conclusions: Tailoring an e-intervention to target group (GPs) characteristics appears to be successful in promoting behavioral change in GPs undertaking vocational training. Significant and lasting changes were observed in determinants of prescribing BZDs. The e-intervention resulted in a positive impact on participants' readiness to adhere to BZD prescribing guidance and their coping with psychosocial consultations. Investigating which mechanisms of change are responsible for the observed effectiveness could help to refine and improve future interventions.

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References

Holbrook A, Crowther R, Lotter A, Cheng C, King D . Meta-analysis of benzodiazepine use in the treatment of insomnia. CMAJ. 2000; 162(2):225-33. PMC: 1232276. View

Matthys J, Elwyn G, van Nuland M, Van Maele G, De Sutter A, De Meyere M . Patients' ideas, concerns, and expectations (ICE) in general practice: impact on prescribing. Br J Gen Pract. 2008; 59(558):29-36. PMC: 2605528. DOI: 10.3399/bjgp09X394833. View

Davy Z, Middlemass J, Siriwardena A . Patients' and clinicians' experiences and perceptions of the primary care management of insomnia: qualitative study. Health Expect. 2013; 18(5):1371-83. PMC: 5060832. DOI: 10.1111/hex.12119. View

Zubin J, Spring B . Vulnerability--a new view of schizophrenia. J Abnorm Psychol. 1977; 86(2):103-26. DOI: 10.1037//0021-843x.86.2.103. View

Lader M . Limitations on the use of benzodiazepines in anxiety and insomnia: are they justified?. Eur Neuropsychopharmacol. 2000; 9 Suppl 6:S399-405. DOI: 10.1016/s0924-977x(99)00051-6. View

Soyka M . Treatment of Benzodiazepine Dependence. N Engl J Med. 2017; 376(12):1147-1157. DOI: 10.1056/NEJMra1611832. View

Butler C, Simpson S, Dunstan F, Rollnick S, Cohen D, Gillespie D . Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial. BMJ. 2012; 344:d8173. PMC: 3270575. DOI: 10.1136/bmj.d8173. View

Edinger J, Means M . Cognitive-behavioral therapy for primary insomnia. Clin Psychol Rev. 2005; 25(5):539-58. DOI: 10.1016/j.cpr.2005.04.003. View

Stepanski E, Wyatt J . Use of sleep hygiene in the treatment of insomnia. Sleep Med Rev. 2003; 7(3):215-25. DOI: 10.1053/smrv.2001.0246. View

10.

Kurko T, Saastamoinen L, Tahkapaa S, Tuulio-Henriksson A, Taiminen T, Tiihonen J . Long-term use of benzodiazepines: Definitions, prevalence and usage patterns - a systematic review of register-based studies. Eur Psychiatry. 2015; 30(8):1037-47. DOI: 10.1016/j.eurpsy.2015.09.003. View

11.

Barker M, Greenwood K, Jackson M, Crowe S . Persistence of cognitive effects after withdrawal from long-term benzodiazepine use: a meta-analysis. Arch Clin Neuropsychol. 2004; 19(3):437-54. DOI: 10.1016/S0887-6177(03)00096-9. View

12.

Bandura A . Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977; 84(2):191-215. DOI: 10.1037//0033-295x.84.2.191. View

13.

Kusurkar R, Croiset G, Ten Cate T . Twelve tips to stimulate intrinsic motivation in students through autonomy-supportive classroom teaching derived from self-determination theory. Med Teach. 2012; 33(12):978-82. DOI: 10.3109/0142159X.2011.599896. View

14.

Prochaska J, DiClemente C . Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983; 51(3):390-5. DOI: 10.1037//0022-006x.51.3.390. View

15.

Holliday S, Morgan S, Tapley A, Henderson K, Dunlop A, Van Driel M . The pattern of anxiolytic and hypnotic management by Australian general practice trainees. Drug Alcohol Rev. 2016; 36(2):261-269. DOI: 10.1111/dar.12404. View

16.

Sirdifield C, Chipchase S, Owen S, Siriwardena A . A Systematic Review and Meta-Synthesis of Patients' Experiences and Perceptions of Seeking and Using Benzodiazepines and Z-Drugs: Towards Safer Prescribing. Patient. 2016; 10(1):1-15. DOI: 10.1007/s40271-016-0182-z. View

17.

Anderson K, Stowasser D, Freeman C, Scott I . Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis. BMJ Open. 2014; 4(12):e006544. PMC: 4265124. DOI: 10.1136/bmjopen-2014-006544. View

18.

Darker C, Sweeney B, Barry J, Farrell M, Donnelly-Swift E . Psychosocial interventions for benzodiazepine harmful use, abuse or dependence. Cochrane Database Syst Rev. 2015; (5):CD009652. PMC: 11023022. DOI: 10.1002/14651858.CD009652.pub2. View

19.

Anthierens S, Habraken H, Petrovic M, Christiaens T . The lesser evil? Initiating a benzodiazepine prescription in general practice: a qualitative study on GPs' perspectives. Scand J Prim Health Care. 2007; 25(4):214-9. PMC: 3379762. DOI: 10.1080/02813430701726335. View

20.

Sirdifield C, Anthierens S, Creupelandt H, Chipchase S, Christiaens T, Siriwardena A . General practitioners' experiences and perceptions of benzodiazepine prescribing: systematic review and meta-synthesis. BMC Fam Pract. 2013; 14:191. PMC: 4028802. DOI: 10.1186/1471-2296-14-191. View