Addressing Barriers to Reducing Prescribing and Implementing Deprescribing of Sedative-Hypnotics in Primary Care

Lisa Burry, Justin Turner, Timothy Morgenthaler, Cara Tannenbaum, Hyung J. Cho, Evelyn Gathecha, Flora Kisuule, Abi Vijenthira, Christine Soong

Research output: Contribution to journalReview articlepeer-review

Abstract

Objective: To describe interventions that target patient, provider, and system barriers to sedative-hypnotic (SH) deprescribing in the community and suggest strategies for healthcare teams. Data Sources: Ovid MEDLINE ALL and EMBASE Classic + EMBASE (March 10, 2021). Study Selection and Data Extraction: English-language studies in primary care settings. Data Synthesis: 20 studies were themed as patient-related and prescriber inertia, physician skills and awareness, and health system constraints. Patient education strategies reduced SH dose for 10% to 62% of participants, leading to discontinuation in 13% to 80% of participants. Policy interventions reduced targeted medication use by 10% to 50%. Relevance to Patient Care and Clinical Practice: Patient engagement and empowerment successfully convince patients to deprescribe chronic SHs. Quality improvement strategies should also consider interventions directed at prescribers, including education and training, drug utilization reviews, or computer alerts indicating a potentially inappropriate prescription by medication, age, dose, or disease. Educational interventions were effective when they facilitated patient engagement and provided information on the harms and limited evidence supporting chronic use as well as the effectiveness of alternatives. Decision support tools were less effective than prescriber education with patient engagement, although they can be readily incorporated in the workflow through prescribing software. Conclusions: Several strategies with demonstrated efficacy in reducing SH use in community practice were identified. Education regarding SH risks, how to taper, and potential alternatives are essential details to provide to clinicians, patients, and families. The strategies presented can guide community healthcare teams toward reducing the community burden of SH use.

Original languageEnglish (US)
JournalAnnals of Pharmacotherapy
DOIs
StateAccepted/In press - 2021

Keywords

  • deprescribing
  • hypnotics
  • prescription
  • primary care
  • sedatives

ASJC Scopus subject areas

  • Pharmacology (medical)

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