Lui Eric, Wintemute Kimberly, Muraca Maria, Truong Christine, Ha Rita, Choe Albert Kee Buhm, Michell Laura, Laine-Gossin Joanne, Blankenstein Harvey, Klein Stephanie, Mayer Dana, Feder Victor, Greiver Michelle
North York Family Health Team, the North York General Hospital and the University of Toronto, Department of Family and Community Medicine, Toronto, Ontario.
Can Pharm J (Ott). 2021 Jun 11;154(4):278-284. doi: 10.1177/17151635211014918. eCollection 2021 Jul-Aug.
Sedative-hypnotic (SH) medications are often used to treat chronic insomnia, with potentially serious long-term side effects. The objective of this study is to evaluate an interprofessional SH deprescribing program within a community team-based, primary care practice, with or without cognitive behavioural therapy for insomnia (CBT-I).
Retrospective chart review for patients referred to the team pharmacist for SH deprescribing from February 2016 to June 2019.
A total of 121 patients were referred for SH deprescribing, with 111 (92%) patients who attempted deprescribing (average age 69, range 29-97 years) and 22 patients who also received CBT-I. Overall, 36 patients (32%) achieved complete abstinence, and another 36 patients (32%) reduced their dosage by ≥50%. For the 36 patients who achieved complete abstinence, 26 (72%) patients remained abstinent at 6 months (9 patients resumed using SH and 1 patient was lost to follow-up). The proportion of patients achieving complete abstinence or reduced dosage of ≥50% (successful tapering) was higher with CBT-I than without CBT-I but did not reach statistical significance (77% vs 62%, = 0.22). There were also no statistically significant differences detected in the success between those who took a benzodiazepine and those who took a Z-drug (67% vs 61%, = 0.55) or for those who took SH daily and those who took them intermittently (67% vs 44%, = 0.09).
Almost two-thirds of patients participating in our pharmacist-led program were able to stop or taper their SH medications by ≥50%. The role of CBT-I in SH deprescribing remains to be further elucidated. 2021;154:xx-xx.
镇静催眠药物常用于治疗慢性失眠，但可能存在严重的长期副作用。本研究的目的是评估在基于社区团队的初级保健实践中开展的跨专业镇静催眠药物减药计划，该计划有无失眠认知行为疗法（CBT-I）。
对2016年2月至2019年6月因镇静催眠药物减药而转诊给团队药剂师的患者进行回顾性病历审查。
共有121名患者因镇静催眠药物减药而被转诊，其中111名（92%）患者尝试减药（平均年龄69岁，范围29 - 97岁），22名患者还接受了CBT-I。总体而言，36名患者（32%）实现了完全停药，另有36名患者（32%）将剂量减少了≥50%。在实现完全停药的36名患者中，26名（72%）患者在6个月时仍保持停药状态（9名患者恢复使用镇静催眠药物，1名患者失访）。接受CBT-I的患者实现完全停药或剂量减少≥50%（成功减药）的比例高于未接受CBT-I的患者，但未达到统计学显著性（77%对62%，P = 0.22）。服用苯二氮䓬类药物的患者与服用Z类药物的患者之间（67%对61%，P = 0.55），以及每天服用镇静催眠药物的患者与间歇性服用的患者之间（67%对44%，P = 0.09），在减药成功方面也未检测到统计学显著性差异。
参与我们由药剂师主导计划的患者中，近三分之二能够停用或减少≥50%的镇静催眠药物剂量。CBT-I在镇静催眠药物减药中的作用仍有待进一步阐明。2021;154:xx - xx。
