Patient Education and Pharmacist Consultation Influence on Nonbenzodiazepine Sedative Medication Deprescribing Success for Older Adults
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INTRODUCTION: Use of nonbenzodiazepine sedative hypnotics or "Z-drugs"-including eszopiclone, zolpidem, or zaleplon-is discouraged for older adults; however, these medications commonly are prescribed to treat insomnia in this population. We evaluated the impact of direct-to-patient education, with or without a pharmacist consultation, on Z-drug discontinuation among Kaiser Permanente Northwest members age 64 years and older. METHODS: We randomized 150 patients to usual care (UC), educational information only, or educational information and pharmacist consultation. Patients age 64 years and older who received 2 to 3 Z-drug fills in 2016 were included. Logistic regression was used to calculate odds of discontinuation at 6 months among patients who received either intervention, compared with those who received UC. RESULTS: Patients who received education only and education plus pharmacist consultation were significantly more likely to discontinue Z-drug use than those who received UC (28/50 of those who received education only and 27/49 of those who received education plus consultation vs 13/50 patients who received UC). After controlling for patient demographics, comorbidity, and antianxiety and antidepressant medication use, patients who received education only had greater odds of Z-drug discontinuation than those in the UC group (adjusted odds ratio = 4.02, 95% confidence interval = 1.66-9.77). Patients who received education and a pharmacist call also had greater odds of discontinuing use of these drugs than those in the UC group (adjusted odds ratio = 4.10, 95% confidence interval = 1.65-10.19). CONCLUSION: Patients who received direct-to-patient education with or without a pharmacist consultation were significantly more likely to discontinue Z-drug use than patients receiving UC. Providing evidence-based information about Z-drug use is an effective and low-resource method to encourage drug discontinuation.
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Findings regarding self-guided CBT-I are inconsistent; some studies demonstrated a significant reduction in Z-drug use among intervention groups compared to controls, while another study reported no significant effect on hypnotic discontinuation.
“Findings regarding self-guided CBT-I are inconsistent. While some studies 78 79 have demonstrated a significant reduction in Z-drug use among individuals in the intervention groups compared to the controls, another study 77 reported no significant effect on hypnotic discontinuation.”
From Z-drug abuse and dependence: Clinical guideline of the Brazilian Academy of Neurology for diagnosis and management (2025) · cites this paper as [78]
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References 18 · Cited by 43
- Authors
- Kuntz, J. L., Kouch, L., Christian, D., Hu, W., & Peterson, P. L.
- Affiliations
- The Center for Health Research, Portland, OR
- Kaiser Permanente (US)
- Northwest Data and Analysis Center, The Center for Health Research, Portland, OR
- Venue
- The Permanente Journal
- Publisher
- The Permanente Federation
- Published
- 2019-03
- Volume
- 23
- Issue
- 1
- Pages
- 18-161
- ISSN
- 1552-5767 (ISSN-L)
- 1552-5775
- PMC
- PMC6326560
- OpenAlex
- W2907989884
- Cited by
- 43
- References
- 18
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 8 · 2023: 12 · 2022: 5 · 2021: 3 · 2020: 4
- FWCI
- 0.97
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- The Permanente Journal (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- Z-drugs, deprescribing, patient education, pharmacist counseling, drug discontinuation, older adults, insomnia, zolpidem, eszopiclone, zaleplon, Kaiser Permanente
- MeSH terms
- Deprescriptions, Aged, Aged, 80 and over, Community Pharmacy Services, Female, Health Services, Humans, Hypnotics and Sedatives, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Patient Education as Topic, Comorbidity, Odds Ratio, Polypharmacy
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