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BENZODIAZEPINES RENEWALS BEYOND RECOMMANDED DURATIONS:

BENZODIAZEPINES RENEWALS BEYOND RECOMMANDED DURATIONS:. Which perceptions do GP’s who prescribe them, have ? J.P. Canévet, P. Le Mauff, R. Senand Département de MG Université de Nantes. CONTEXT and PURPOSE. Long term treatments with benzodiazepines are usual in France.

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BENZODIAZEPINES RENEWALS BEYOND RECOMMANDED DURATIONS:

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  1. BENZODIAZEPINES RENEWALS BEYOND RECOMMANDED DURATIONS: Which perceptions do GP’s who prescribe them, have ? J.P. Canévet, P. Le Mauff, R. Senand Département de MG Université de Nantes

  2. CONTEXT and PURPOSE • Long term treatments with benzodiazepines are usual in France. • Practitioners demobilization is often denounced. • Direct observation of prescription situations conclude to contrasted results. • Main purpose : identifying GPs intentions and representations, • Second purpose : . verifying if GPs are motivated to explore psychic life of their patients, . evaluating importance of compassion in their professionnal identity.

  3. METHOD  • Two focus groups including General Practitioners from 2 French Departments (Loire Atlantique / Vendée) • A grid of questions to explore the 3 EBM fields : - theoretical representation of treatments using benzodiazepines ? - representation of the patient request ? - suggestions to improve benzodiazepine prescription ( so that GPs intentions and GPs value systems can appear) ? • Registered and transcripted discussion • Content analysis (using a grid)

  4. RESULTS (1)KNOWLEDGE BUT LIMITED APPLICATION • GPs have a good knowledge concerning theoretical data and prescription risks. • None of them speaks about the necessity of an evaluation concerning : - insomnia or anxiety linked problems , - dependance intensity. • A minority does not recognize dependance reality.

  5. RESULTS (2)PATIENT REQUEST ANALYSIS :COMPASSION OR SELF-JUSTIFICATION ? Benzodiazepine request is justified as : - a request to relieve existential suffering ( and not a pathology) - a sign of social dysfunction - a denial of depression - addiction expression

  6. RESULTS (3)A KNOWN EMBARRASSMENT Participants had a good vision of their loss of professionnal identity, considering : - risks knowledge, and care about good practice, - identification of suffering and addiction for the patient, - and difficulty as withdrawal is concerned.

  7. RESULTS (4)WHY DO THEY PRESCRIBE ? All the GP’s prescribed with resignation : • not to face the withdrawal problems , • fatalism after a failure , • Not to face the risk of a possible destabilisation in chronical situations.

  8. RESULTS (5)GP JUSTIFICATIONS TO KEEP PROFESSIONALSELF-ESTIM • Sometimes with denying risks , • Other times attesting their intention to avoid more important risks (alcohol,...) • and sometimes to avoid conflict • In all cases : confusion between anxiety and dependance

  9. RESULTS (6)DIFFERENT SILENCES • None of the GPs speaks about the lack of consensual and valid rules to help patient in the withdrawal process, • None of them speaks about the institutional context (private system / pay per act medicine) • None of them speaks about the possible use of benzodiazepine by GPs themselves.

  10. RESULTS (7)INCOMPETENTS / COMPASSIONNAL GPs We observed an agreement concerning : (7.1) A feeling of incompetence as far as questioning psychic life of their patient is concerned. (7.2) A specific attention to favor a help and support relation in situations where patient is suffering

  11. RESULTS (7.1)A FEELING OF INCOMPETENCE ( IN THE DOCTOR/PATIENT RELATION ) • A lack of words to caracterize care without use of drugs • An almost exclusive pedagogic conception: - « explain » sleeping physiology,    - « explain » anxiety symptoms • A wish to delegate the job to psychologists and to patients groups.

  12. RESULTS (7.2)A PROFESSIONAL IDENTITY CARACTERIZED BY COMPASSION Strong proclamations attesting the specific attention to relieve… • « to give a shoulder to lean on » • « to provide well-being » • « to help suffering humanity » • « to care for « life injuries »  »

  13. CONCLUSION BENZODIAZEPINES : « A TRANSITIONNAL OBJECT » ? A CONTRADITIONbetween . compassion and . incompetence feeling, • that creates a sufferingin the population of prescriptors in front of the patients that suffer too, • that motivates a prescription as a symbol , symbol of a care relation that neither the doctor, neither his patient want to stop with a withdrawal.

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