Associations Between Primary Care Clinician Beliefs Related to BZD Prescribing and Patient-Level Risk of Being Prescribed a BZD
| Survey Item | Clinicians, No. (%) (n = 61) | Patients, No. (%) (n = 5,385)a | Patients Filling BZD, No. (%)b | Adjusted RR (95% CI)c |
|---|---|---|---|---|
| The following statements were introduced by, “To what extent do you agree with the following statement about benzodiazepine treatment?” | ||||
| If a patient has been prescribed a benzodiazepine for years, the potential harms from continuing the benzodiazepine are low. | ||||
| Strongly disagree/disagree | 38 (62.3) | 3,352 (62.2) | 403 (12.0) | 1.0 (reference) |
| Neither | 12 (19.7) | 908 (16.9) | 75 (8.3) | 0.67 (0.47-0.94)d |
| Agree/strongly agree | 11 (18.0) | 1,125 (20.9) | 167 (14.8) | 1.31 (1.01-1.7)d |
| If a patient has been prescribed a benzodiazepine for years, a taper would be an unnecessary source of distress. | ||||
| Strongly disagree/disagree | 52 (85.2) | 4,750 (88.2) | 588 (12.4) | 1.0 (reference) |
| Neither | 7 (11.5) | 483 (9.0) | 37 (7.7) | 0.7 (0.36-1.36) |
| Agree/strongly agree | 2 (3.3) | 152 (2.8) | 20 (13.2) | 1.09 (0.75-1.6) |
| Patients are usually unwilling to be tapered off benzodiazepines. | ||||
| Strongly disagree/disagree | 9 (14.8) | 991 (18.4) | 144 (14.5) | 1.0 (reference) |
| Neither | 13 (21.3) | 1,299 (24.1) | 156 (12.0) | 0.82 (0.58-1.15) |
| Agree/strongly agree | 39 (63.9) | 3,095 (57.5) | 345 (11.1) | 0.73 (0.5-1.04) |
| For anxiety, benzodiazepines work better than other treatments. | ||||
| Strongly disagree/disagree | 33 (54.1) | 3,042 (56.5) | 372 (12.2) | 1.0 (reference) |
| Neither | 21 (34.4) | 1,750 (32.5) | 214 (12.2) | 1.03 (0.79-1.33) |
| Agree/strongly agree | 7 (11.5) | 593 (11.0) | 59 (9.9) | 0.82 (0.48-1.4) |
| For insomnia, benzodiazepines work better than other treatments. | ||||
| Strongly disagree/disagree | 43 (70.5) | 3,700 (68.7) | 444 (12.0) | 1.0 (reference) |
| Neither | 12 (19.7) | 1,055 (19.6) | 129 (12.2) | 1.04 (0.79-1.37) |
| Agree/strongly agree | 4 (6.6) | 415 (7.7) | 50 (12.0) | 0.99 (0.6-1.62) |
| No response | 2 (3.3) | 215 (4.0) | 22 (10.2) | NA |
| Tapering a benzodiazepine would involve more frequent patient visits. | ||||
| Strongly disagree/disagree | 9 (14.8) | 789 (14.7) | 86 (10.9) | 1.0 (reference) |
| Neither | 10 (16.4) | 1,086 (20.2) | 159 (14.6) | 1.38 (0.87-2.18) |
| Agree/strongly agree | 42 (68.9) | 3,510 (65.2) | 400 (11.4) | 1.0 (0.65-1.54) |
| In the past year, among all your patients who take benzodiazepines regularly (either scheduled or PRN), with what percentage of patients did you discuss decreasing or discontinuing the benzodiazepine? | ||||
| 0% | 0 | NA | NA | NA |
| 1% to 25% | 7 (11.5) | 597 (11.1) | 76 (12.7) | 1.0 (reference) |
| 26% to 50% | 16 (26.2) | 1,463 (27.2) | 185 (12.6) | 0.98 (0.67-1.43) |
| 51% to 75% | 16 (26.2) | 1,254 (23.3) | 148 (11.8) | 0.96 (0.64-1.43) |
| 76% to 100% | 21 (34.4) | 1,981 (36.8) | 232 (11.7) | 0.89 (0.61-1.32) |
| No response | 1 (1.6) | 90 (1.7) | 4 (4.4) | NA |
BZD = benzodiazepine; NA = not applicable; PRN = pro re nata (as needed); RR = relative risk.
↵a These 5,385 patients were all Medicare beneficiaries who filled a Part D prescription in 2017 written by the 61 clinician survey respondents.
↵b Among patients of clinicians with a given response level (eg, among 3,352 patients whose clinicians disagreed or strongly disagreed with the statement, “If a patient has been prescribed a benzodiazepine for years, the potential harms from continuing the benzodiazepine are low,” 403 [12.0%] filled a BZD prescribed by those clinicians).
↵c From a modified Poisson regression model with robust SE values. Adjusted for patient age, gender, and Part D low-income subsidy.
↵d P < .05