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

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 inter-professional 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.

Automated summary

The study evaluated the effectiveness of a community team-based inter-professional sedative-hypnotic deprescribing program, finding that nearly two-thirds of patients participating were able to successfully discontinue or taper their medications by >= 50%. The role of CBT-I in sedative-hypnotic deprescribing still needs further elucidation.