Análise da prescrição de benzodiazepínicos pelo médico de família em uma amostra no município do Rio de Janeiro.

Abstract

This qualitative research was carried out in order to reflect on the determinants of the decision of general practitioners as regards the prescription of benzodiazepines, on a primary primary atention setting, in the city of Rio de Janeiro. An analysis was sought to be elaborated, about how the use of benzodiazepines is negotiated between the physician and the user, investigating the meanings of these drugs in the imaginary of prescribers, together with the alternative resources taken into account by the team, in the studied sample. General practitioners settled on primary atention were recruited, an invitation was sent to offer participating in the interview, by text message or e-mail. The candidates gave acceptance signing free and informed consent form, responding a semi-structured questionnaire that was recorded and transcribed verbatim for analysis. The questionaire addressed physician's perception of complaints in benzodiazepines users; application of discontinuation strategies and alternatives offered instead of medicines, during consultation. Twelve professionals were interviewed from August to December 2017. Interviewees reported a predominance of consultations for repetition of benzodiazepine prescription. Anxiety and insomnia were cited as the most frequent reasons for use. There was also mention of nonspecific somatic complaints, chronic pain, arterial hypertension and dependence. All the interviewees reported concern about optimization and reduction of benzodiazepine doses. Eleven of the interviewees expressed their intention to make discontinuation proposals, once the therapeutic alliance was established. Meanwhile, the success rate of this type of intervention was evaluated as low, on interviewees' perception. Leisure activities, physical exercise, inclusion in support groups and referral to especialized support team were mentioned as alternatives to benzodiazepines. The commitment to the rational use of benzodiazepines in contrast with concern about indiscriminate use manifested themselves in pressure, dilemmas and constraints reported by general practitioners during the interviews. Building a ranking of complaints together with users offers the opportunity of shared care team work, where medication use is one of the available resources. This kind of investment on integrality, at a larger scale, might have consequences on population s health, in terms of use of medicines.