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

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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.

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Acknowledgements

We would like to recognise the contributions of the pharmacists who participated in the interviews, without whom this study would not have been possible.

Funding

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

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Authors and Affiliations

  1. School of Pharmacy and Bioengineering, Keele University, Keele, UK

    Tomazo Joseph Kallis & Maria Allinson

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  1. Tomazo Joseph Kallis
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  2. Maria Allinson
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Correspondence to Tomazo Joseph Kallis.

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Kallis, T.J., Allinson, M. Factors affecting clinical pharmacist decision-making when reviewing and prescribing z-drugs in primary care: a qualitative interview study. Int J Clin Pharm 45, 1176–1183 (2023). https://doi.org/10.1007/s11096-023-01617-6

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  • DOI: https://doi.org/10.1007/s11096-023-01617-6

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