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Dificuldades na desprescrição de benzodiazepinas: Uma revisão sistemática
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Abstract(s)
A presente revisão sistemática, com o título “Dificuldades na desprescrição de
benzodiazepinas” tem como principal objetivo identificar e analisar as barreiras enfrentadas
na descontinuação destes fármacos, tanto da perspetiva dos profissionais de saúde, como dos
pacientes.
A pesquisa de estudos foi realizada nas bases de dados Pubmed e B-on, sendo a data da última
pesquisa a 21 de abril de 2024. Foram incluídos estudos em português, inglês e espanhol,
publicados entre 2014 e 2023. Foram excluídos outros artigos de revisão, estudos que não
focassem no objetivo do trabalho e estudos cuja amostra fossem pacientes com menos de 45
anos. Para avaliação de qualidade usou-se o CASP Qualitative Checklist. Seguindo as diretrizes
do PRISMA, a seleção dos estudos e a recolha de dados realizou-se em múltiplas etapas, como
eliminação de duplicados no software Mendeley, aplicação dos critérios de elegibilidade e
elaboração da tabela de extração de dados.
Foram incluídos na revisão oito estudos, sendo três destes baseados em entrevistas
semiestruturadas a profissionais de saúde e os restantes cinco estudos em indivíduos
consumidores de benzodiazepinas. O tamanho das amostras variou entre 11 e 261 indivíduos
entrevistados. Os resultados apresentaram como barreiras importantes a baixa autoeficácia
para a desprescrição percecionada pelos profissionais de saúde, fatores externos como falta de
tempo e falta de recursos, resistência por parte dos pacientes, estabilidade clínica,
responsabilidade deferida e falta de colaboração entre serviços. Pelas entrevistas aos
consumidores de benzodiazepinas, as principais dificuldades são a falta de motivação, a
preocupação com o ressurgimento dos sintomas de base, a síndrome de abstinência e a
subestimação dos efeitos adversos.
Quanto às limitações desta revisão, não podem ser descartados o viés de publicação e de
seleção de artigos, o viés de heterogeneidade, a distrubuição geográfica dos estudos pouco
variada e o possível desvio do objetivo com a inclusão de três artigos que analisaram, para além
das benzodiazepinas, ópioides.
Tendo em conta estes resultados e o facto de Portugal ser um dos países com consumo mais
elevado de benzodiazepinas, é essencial para a contínua melhoria dos cuidados médicos e para
a perspetiva de saúde pública atuar para colmatar estas barreiras, nomeadamente através de
guidelines atualizadas e protocolos que orientem a desprescrição e aumentem a confiança dos
profissionais. Também é preponente reforçar as orientações médicas aquando da prescrição de
benzodiazepinas acerca dos riscos do uso prolongado da medicação e do seu efeito de tolerância
e dependência, uma vez que a perceção geral dos consumidores é muitas vezes de subestimação
ou negação dos efeitos adversos e de necessidade da medicação, mesmo após longos períodos.
The present systematic review, titled "Difficulties in benzodiazepine deprescribing" aims to identify and analyze the barriers faced in the discontinuation of these drugs, from both healthcare professionals' and patients' perspectives. The study search was conducted in the Pubmed and B-on databases, with the last search date being April 21, 2024. Studies in portuguese, english, and spanish, published between 2014 and 2023, were included. Other review articles, studies not focusing on this review´s goal, and studies with samples of patients under 45 years old were excluded. The CASP Qualitative Checklist was used for quality assessment. Following PRISMA guidelines, study selection and data collection were carried out in multiple stages, including duplicate elimination in Mendeley software, application of eligibility criteria, and development of a data extraction table. Eight studies were included in this review, three of which were based on semi-structured interviews with healthcare professionals, and the remaining five studies focused on older adults and elderly benzodiazepine consumers. Sample sizes ranged from 11 to 261 interviewed individuals. The results presented important barriers such as low self-efficacy for deprescribing perceived by healthcare professionals, external factors like lack of time and resources, patient resistance, clinical stability, deferred responsibility, and lack of collaboration between services. From interviews with benzodiazepine consumers, the main difficulties were lack of motivation, concern about the resurgence of underlying symptoms, withdrawal syndrome, and underestimation of adverse effects. Regarding the systematic review's limitations, publication and article selection bias, heterogeneity bias, limited geographical distribution of studies, and possible deviation from the objective with the inclusion of three articles that analyzed opioids in addition to benzodiazepines cannot be ruled out. Considering these results and the fact that Portugal is one of the countries with the highest levels of benzodiazepine consumption, it is essential for the continuous improvement of medical care and from a public health perspective to address these barriers, namely through updated guidelines and protocols that guide deprescribing and increase the professionals´ confidence. It is also preponderant to reinforce medical guidance when prescribing benzodiazepines about the risks of prolonged medication use and its tolerance and dependence effect, since the general perception of consumers is often one of underestimation or denial of adverse effects and medication necessity, even after long periods of time.
The present systematic review, titled "Difficulties in benzodiazepine deprescribing" aims to identify and analyze the barriers faced in the discontinuation of these drugs, from both healthcare professionals' and patients' perspectives. The study search was conducted in the Pubmed and B-on databases, with the last search date being April 21, 2024. Studies in portuguese, english, and spanish, published between 2014 and 2023, were included. Other review articles, studies not focusing on this review´s goal, and studies with samples of patients under 45 years old were excluded. The CASP Qualitative Checklist was used for quality assessment. Following PRISMA guidelines, study selection and data collection were carried out in multiple stages, including duplicate elimination in Mendeley software, application of eligibility criteria, and development of a data extraction table. Eight studies were included in this review, three of which were based on semi-structured interviews with healthcare professionals, and the remaining five studies focused on older adults and elderly benzodiazepine consumers. Sample sizes ranged from 11 to 261 interviewed individuals. The results presented important barriers such as low self-efficacy for deprescribing perceived by healthcare professionals, external factors like lack of time and resources, patient resistance, clinical stability, deferred responsibility, and lack of collaboration between services. From interviews with benzodiazepine consumers, the main difficulties were lack of motivation, concern about the resurgence of underlying symptoms, withdrawal syndrome, and underestimation of adverse effects. Regarding the systematic review's limitations, publication and article selection bias, heterogeneity bias, limited geographical distribution of studies, and possible deviation from the objective with the inclusion of three articles that analyzed opioids in addition to benzodiazepines cannot be ruled out. Considering these results and the fact that Portugal is one of the countries with the highest levels of benzodiazepine consumption, it is essential for the continuous improvement of medical care and from a public health perspective to address these barriers, namely through updated guidelines and protocols that guide deprescribing and increase the professionals´ confidence. It is also preponderant to reinforce medical guidance when prescribing benzodiazepines about the risks of prolonged medication use and its tolerance and dependence effect, since the general perception of consumers is often one of underestimation or denial of adverse effects and medication necessity, even after long periods of time.
Description
Keywords
Barreiras Benzodiazepinas Descontinuação Desprescrição Revisão Sistemática