Factors affecting clinical pharmacist decision-making when reviewing and prescribing z-drugs in primary care: a qualitative interview study.

Kallis, Tomazo Joseph; Allinson, Maria

Abstract

Background
Z-drugs (zopiclone, zolpidem and zaleplon) are drugs with dependence forming characteristics licensed for the short-term management of insomnia. Patients regularly prescribed z-drugs are candidates for ‘structured medication reviews’, routinely delivered by pharmacists employed in general practice or primary care networks in England.

Aim
To understand the factors that affect pharmacist decision-making when reviewing and prescribing z-drugs in primary care.

Method
Qualitative semi-structured interviews with general practice based pharmacists were conducted using MS Teams®. Clinical vignettes to simulate real-world practice were sent to participants and then discussed at interview, followed by structured interview questions. Interview transcripts were thematically analysed to identify themes and sub-themes expressed by participants.

Results
Three over-arching themes emerged over the course of qualitative interviews with 10 clinical pharmacists: the perceived role of the pharmacist in deprescribing, the decision-making process, and perceptions of best practice. Pharmacists highlighted that relationships with patients were an important foundation for medication reviews regarding z-drugs and that at times they felt pressure to continue prescribing z-drugs beyond their licensed use. Participants explored rule-based reasoning and compassionate care when rationalising their decision-making for reviewing and prescribing z-drugs.

Conclusion
Patient factors, time pressures, ‘rule-based’ beliefs and pharmacist self-efficacy were key practice aspects which can influence the pharmacist decision-making process when reviewing or prescribing z-drugs. Pharmacists believed z-drugs should be short-term interventions for insomnia, with non-pharmacological, holistic treatment being more appropriate for long term management.

Citation

Kallis, T. J., & Allinson, M. (in press). Factors affecting clinical pharmacist decision-making when reviewing and prescribing z-drugs in primary care: a qualitative interview study. International Journal of Clinical Pharmacy, https://doi.org/10.1007/s11096-023-01617-6

• Journal Article Type: Article
• Acceptance Date: Jun 21, 2023
• Online Publication Date: Jul 15, 2023
• Deposit Date: Aug 14, 2023
• Publicly Available Date: Jul 16, 2024
• Journal: International journal of clinical pharmacy
• Electronic ISSN: 2210-7711
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1007/s11096-023-01617-6
• Keywords: Clinical reasoning, Deprescriptions, Medication review, Sleep initiation and maintenance disorders, Zolpidem, Zopiclone