title: Role of community pharmacists in the detection of potentially inappropriate benzodiazepines prescriptions for insomnia.
abstract: BACKGROUND
  The appropriate management of chronic insomnia is crucial and prescribing of hypnotic drugs is common. Regular and prolonged use of hypnotics should be avoided because of the risk of tolerance to effects, dependence and an increased risk of adverse events. In 2012, updated Beers criteria for potentially inappropriate medication in older adults suggested to avoid all benzodiazepines in older adults to treat insomnia. In addition, successful discontinuation may result in improvements on cognitive and psychomotor function, particularly in older people.
  
  
  OBJECTIVE
  To investigate the appropriateness of benzodiazepines prescription for insomnia and explore the role that community pharmacists can have in identifying signals of potential inappropriate drug prescriptions.
  
  
  METHODS
  Community pharmacies in Italy.
  
  
  METHODS
  This is an observational study conducted in 8 community pharmacies. Each pharmacist was asked to interview a sample of patients with the prescriptions of at least one benzodiazepine and to complete a minimum data set collecting information about socio-demographic characteristics, drug indication, duration of drug prescription, number of hypnotic-drugs, previous attempt to drug-discontinuation, preference of patients about benzodiazepine withdrawal and modality of drug tapering. Main outcome measure Indications, treatment duration, dosage and drug discontinuation attempts and modalities.
  
  
  RESULTS
  A total of 181 participants were interviewed. About half of respondents (n = 81) reported to be treated for insomnia and 62 % were elderly (mean age 68, range 27-93). Fifty-two patients (64 %) were on long term treatment (>3 years) while for thirteen patients (16 %) duration of treatment was comprised between 1 and 3 years. Thirty-three patients were in favour of benzodiazepine-discontinuation but in all cases discontinuation was unsuccessful.
  
  
  CONCLUSIONS
  Use of community pharmacy survey data allowed us to obtain information about incorrect management of insomnia and inappropriate benzodiazepines prescriptions. Stricter adherence to evidence-based guidelines is essential for a rational use of hypnotic and sedatives.
authors.affiliation: Biomedicine Sector, CRS4 Science and Technology Park Polaris, Piscina Manna, 09010, Pula, CA, Italy. silvanaurru@crs4.it.
authors.forename: Silvana Anna Maria
authors.initials: SA
authors.lastname: Urru
authors.affiliation: IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Pasina
authors.affiliation: Department of Pharmaceutical Sciences, Università degli Studi di Milano, Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Minghetti
authors.affiliation: Dipartimento Scienze della Vita, Università degli Studi di Trieste, Trieste, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Giua
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001569:Benzodiazepines / Q000627:therapeutic use*; D003157:Community Pharmacy Services / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D007558:Italy; D008297:Male; D008875:Middle Aged; D010595:Pharmacists; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy*; D012959:Socioeconomic Factors; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control / Q000628:therapy
chemical_list: D006993:Hypnotics and Sedatives; D001569:Benzodiazepines
keywords: Benzodiazepines; Community pharmacies; Elderly; Insomnia; Italy; Medication appropriateness; Pharmacoepidemiology