Prolonged use of benzodiazepine in primary health care: evaluation of effectiveness, dependence and cognitive function

Anxiety and insomnia are global health challenges often managed in Primary Health Care (PHC). Benzodiazepines (BZD) are commonly prescribed, but prolonged use increases risks such as cognitive impairment, dependence, and tolerance. This study assessed PHC users with prolonged BZD use for anxiety or insomnia, focusing on dependence, effectiveness, and cognitive function. A cross-sectional study was conducted with 144 prolonged BZD users in PHC. Data collection included sociodemographic and clinical questionnaires, alongside instruments assessing dependence, cognition, insomnia, and anxiety. Logistic regression analyses were performed. Participants had a mean age of 64.3 years (SD=10.97) and average BZD use duration of 10 years. Prevalence of polypharmacy (54.9%), high anticholinergic load (41%), falls (29.2%), and alcohol use (33.4%) was observed. Falls were linked to severe problematic BZD use, while aging, cognitive impairment, mild insomnia, and lower anxiety were linked to less severe use. Severe insomnia correlated with extreme concerns about medication availability. Older age, white race, and better insomnia or anxiety profiles reduced non-adherence risks, whereas illiteracy increased them. Severe withdrawal symptoms elevated fall risk. Findings stress the need for BZD deprescription.

焦虑与失眠均为全球性公共卫生挑战，且通常在基层医疗（Primary Health Care, PHC）体系中得到处置。苯二氮䓬类药物（Benzodiazepines, BZD）是临床常用处方药物，但长期使用会增加认知损害、药物依赖及耐受等风险。本研究针对因焦虑或失眠长期使用苯二氮䓬类药物的基层医疗使用者展开评估，重点关注药物依赖、治疗有效性与认知功能。研究纳入144名基层医疗体系中的长期苯二氮䓬类药物使用者，开展横断面研究。数据收集包含社会人口学问卷与临床问卷，同时辅以用于评估药物依赖、认知功能、失眠及焦虑状况的测评工具。研究采用逻辑回归分析进行统计检验。研究对象的平均年龄为64.3岁（标准差SD=10.97），苯二氮䓬类药物的平均使用时长为10年。本研究观察到多重用药（54.9%）、高抗胆碱能负荷（41%）、跌倒（29.2%）及酒精使用（33.4%）的现患率。跌倒与苯二氮䓬类药物的严重不当使用存在关联；而年龄增长、认知损害、轻度失眠及焦虑程度较低，则与药物使用程度较轻相关。严重失眠与对药物可及性的极度担忧呈正相关。年龄较大、白人种族及失眠或焦虑症状改善可降低用药不依从风险，而文盲状态则会升高该风险。严重的药物戒断症状会增加跌倒风险。本研究结果强调了对苯二氮䓬类药物实施减停治疗的必要性。