Pharmacist-led sedative-hypnotic deprescribing in team-based primary care practice

Abstract

Background: Sedative-hypnotic (SH) medications are often used to treat chronic insomnia, with potentially serious long-term side effects. The objective of this study is to evaluate an interprofessional SH deprescribing program within a community team-based, primary care practice, with or without cognitive behavioural therapy for insomnia (CBT-I). Methods: Retrospective chart review for patients referred to the team pharmacist for SH deprescribing from February 2016 to June 2019. Results: A total of 121 patients were referred for SH deprescribing, with 111 (92%) patients who attempted deprescribing (average age 69, range 29-97 years) and 22 patients who also received CBT-I. Overall, 36 patients (32%) achieved complete abstinence, and another 36 patients (32%) reduced their dosage by ≥50%. For the 36 patients who achieved complete abstinence, 26 (72%) patients remained abstinent at 6 months (9 patients resumed using SH and 1 patient was lost to follow-up). The proportion of patients achieving complete abstinence or reduced dosage of ≥50% (successful tapering) was higher with CBT-I than without CBT-I but did not reach statistical significance (77% vs 62%, p = 0.22). There were also no statistically significant differences detected in the success between those who took a benzodiazepine and those who took a Z-drug (67% vs 61%, p = 0.55) or for those who took SH daily and those who took them intermittently (67% vs 44%, p = 0.09). Conclusion: Almost two-thirds of patients participating in our pharmacist-led program were able to stop or taper their SH medications by ≥50%. The role of CBT-I in SH deprescribing remains to be further elucidated. Can Pharm J (Ott) 2021;154:xx-xx.

Impact of Specialized Clinics on Medications Deprescribing in Older Adults: A Pilot Study in Ambulatory Care Clinics in a Teaching Hospital

“…The collaboration resulted in a significant reduction in the number of PIMs immediately and at 12-month follow up compared to the control group. Our results also underscore the benefits of engaging specialized health care professionals, including the expertise of geriatricians and clinical pharmacists, to lead and sustain deprescribing efforts in the busy primary care setting to improve patient outcomes ( Lui et al, 2021 , Wong et al, 2021 ).…”

The role of pharmacists in deprescribing benzodiazepines: A scoping review

“…The twenty studies included in the review were conducted in different health settings: hospitals ( n = 8), 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 community pharmacies ( n = 4), 25 , 45 , 46 , 47 and primary care centres ( n = 2). 24 , 48 Other settings include intermediary care, such as subacute medical outpatient clinics, 22 residential care settings, 23 , 49 long-term care, 50 nursing facilities, 51 and geriatric oncology clinics at cancer centres. 52 Most of the studies were conducted in high-income countries, including Canada ( n = 7), 38 , 43 , 45 , 46 , 47 , 48 , 50 United States of America ( n = 4) (USA), 24 , 37 , 39 , 52 Australia ( n = 3), 41 , 44 , 49 Denmark ( n = 2), 22 , 40 and Netherlands (n = 2).…”

Evaluation of a benzodiazepine deprescribing quality improvement initiative for older adults in primary care

“…This evaluation is one of the few studies that evaluate a combined patient‐ and clinician‐outreach method aimed at benzodiazepine deprescribing in a primary care setting. Previous US and Canadian studies of pharmacist‐led benzodiazepine tapering have focused on both younger and older adult populations referred by clinicians, rather than through direct patient outreach, and found comparatively higher benzodiazepine discontinuation rates 15,16 . Additionally, the EMPOWER trial, a Canadian cluster randomized trial which examined direct patient outreach via an educational brochure in outpatient pharmacy settings found that 67% of participants discussed deprescribing with their physicians and 27% completely or partially tapered benzodiazepines 17 .…”