La déprescription des benzodiazépines et z-drugs chez les personnes agées à domicile : comment améliorer la collaboration entre médecin généraliste et pharmacien ? Étude qualitative à l’aide d’entretiens individuels semi-dirigés en Belgique francophone

Details

Supervisors

De Jonghe, Michel

Degree label

Master complémentaire en médecine générale

Abstract

Introduction : In Belgium, in 2016, it was estimated that more than one out of three patients over 75 years of age 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 difficulty in managing this problem. They do not deprescribe enough because they are held back by a whole series of factors. Pharmacists, on the other hand, do not always dare to propose a deprescription to the elderly patient because they do not want to bypass the physician. Collaboration between these providers in Belgium seems to be lacking, even though the literature shows that it would be very useful in reducing this consumption. The interest of this study is therefore to study how to improve this collaboration. Methodology : A literature review in different search engines was carried out, followed by a qualitative study using individual semi-directed interviews with French-speaking pharmacists and general practitioners from different Walloon and Brussels municipalities. An interview guide with open questions oriented on the different objectives of the study led each interview. Subjects were recruited mainly by e-mail. The inclusion and exclusion criteria are few in order to guarantee a large diversity of practices. The analysis by analytical questioning 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 the deprescribing of BZDs and Z-drugs is a difficult and under-practiced task for both the physician and the pharmacist. Collaboration between these providers 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. The use of the telephone and electronic prescriptions are the two communication tools currently available, but computer softwares are mentioned as potential aids. These exchanges should allow the physician to transmit his or her desire or agreement for a deprescription to the pharmacist who has made such a proposal, without forgetting the patient, who remains an unquestionable actor in this process. Conclusion : To deprescribe more effectively, the collaboration between the general practitioner and the pharmacist must be bilaterally motivated. The physician should be more proactive in proposing deprescribing schemes and offering 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. In the future, software should facilitate exchanges, but the challenge will be not to exclude the patient from the process.