i. Rationale, Aims and Objectives: Despite guideline recommendations
against their use, clinicians prescribe benzodiazepines for various
symptoms to patients with posttraumatic stress disorder (PTSD).
Clinicians’ reasons in making these decisions are not fully understood.
This qualitative study sought to characterize factors identified by
prescribing clinicians in clinical decision making in PTSD regarding the
use of benzodiazepines. ii. Methods: The descriptive study involved
semi-structured interviews with 26 prescribing clinicians across
thirteen VA medical centers. Our overall aim in the study was to explore
clinicians’ benzodiazepine practices in veterans with a PTSD diagnosis.
We audio-recorded, transcribed, and analyzed the interviews using
grounded theory methodology. iii. Results: Facilitators and barriers
that contribute to benzodiazepine prescribing to veterans with PTSD
included organizational, provider, and patient aspects. Most providers
interviewed indicated that they inherited patients already on these
medications initiated by other clinicians. These providers, as well as
others interviewed, voiced concerns that tapering benzodiazepines may
cause more harm than the risks of maintenance, particularly in older
patients. Clinicians who noted consistent treatment practices among
their hospital colleagues found it easier to decrease both new and
maintenance benzodiazepine prescribing. iv. Conclusions: Patients with
PTSD at increased risk of harms, such as older patients, are still
receiving benzodiazepines suggesting that innovative solutions are now
needed to decrease use. Specific protocols for inherited patient
caseloads, increased dissemination of effective psychotherapies for
symptoms such as insomnia and anxiety and the use of direct to consumer
educational materials should help to foster needed culture change and
increased evidence-based PTSD practice.