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

Tomazo Kallis, Maria Allinson

Research output: Contribution to journalArticlepeer-review

1 Citation (SciVal)

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.

Original languageEnglish
Number of pages8
JournalInternational Journal of Clinical Pharmacy
DOIs
Publication statusPublished - 15 Jul 2023

Bibliographical note

Funding Information:
This work was supported by the East Cornwall Primary Care Network who in part funded this research.

Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Springer Nature Switzerland AG.

Keywords

  • Clinical reasoning
  • Deprescriptions
  • Medication review
  • Sleep initiation and maintenance disorders
  • Zolpidem
  • Zopiclone

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacy
  • Toxicology
  • Pharmacology
  • Pharmaceutical Science

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