Benzodiazepines deprescribing in the elderly : which collaboration between general practionner and pharmacist?

Manon De Montigny

Keywords: Benzodiazepines, z-drugs, deprescribing, collaboration, pharmacist, general practitioner

Background:

In Belgium, in 2016, it was estimated that more than one out of three patients over 75 used benzodiazepines or z-drugs. Despite a general awareness of the non-indication of these molecules for chronic use in the elderly, general practitioners have great difficulties. Although the literature shows that the collaboration between pharmacist and GP is very useful in reducing this consumption, this seems to be missing in Belgium.

Research questions:

How can we explain the lack of collaboration between these providers on this issue? What kind of partnership do they imagine for the future?

Method:

A literature review followed by a qualitative study using individual semi-directed interviews with French-speaking pharmacists and general practitioners. The coding analysis is iterative and the results are obtained by the consensus of two independent researchers.

Results:

Interviews were conducted with 6 general practitioners and 6 pharmacists. They confirmed that this deprescribing is a difficulty and is underpracticed for both the physician and the pharmacist. Collaboration between them is currently rare, although both are in need of more support. The physician wants to maintain leadership in deprescribing but wants the support of the pharmacist. The pharmacist expects the physician to provide clearer indications in order to better support patients in the process. Their exchanges should allow the physician to transmit his desire or agreement for a deprescription to the pharmacist who has made such a proposal. This collaboration, for example by phone or software should not exclude the patient, who remains an unquestionable actor in this process.

Conclusions:

To deprescribe more effectively, the collaboration between GP and pharmacist must be bilaterally motivated. The physician should be more proactive in proposing deprescribing schedules and should offer a more established place for the pharmacist in this process. The pharmacist should more easily contact the physician to propose a decrease in a patient's medication.

Points for discussion:

Both GPs and pharmacists denounce the abundance of means of communication. They want a clearer channel of communication, but offer many ways to get in touch in interviews. How can we agree on the most effective method of collaboration? Government initiative or case by case?

If collaboration between GPs and pharmacists is more fluid, how can we ensure that the patient is involved throughout the process?

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