Evaluating regional/rural community pharmacists’ confidenceand views of prescribing melatonin: A qualitative study

Main Article Content

Bonnie Nugent
Alison Musk
Joseph Tucci
Lauren Booker

Keywords

melatonin, Insomnia, Sleep disorders, Community pharmacist, pharmacist, Health Services Accessibility, Rural Health Services

Abstract

Background: With recent changes to regulations in Australia allowing community pharmacists to prescribe melatonin to people aged 55 and older as a schedule 3 or ‘over the counter’ medicine, their knowledge of insomnia and the safety of melatonin needs to be assessed. Objective: The study aims to investigate the perceptions and confidence of community pharmacists on the supply of melatonin to patients with sleep issues. Methods: Ten community pharmacists located in regional Victoria participated in semi structured interviews. Interviews were recorded and later transcribed verbatim. Transcriptions were de-identified and thematically analysed. Results: Five overarching themes were identified: (1) the accessibility and practicality of pharmacists prescribing melatonin, (2) a lack of confidence in assessing sleep issues (3) a high confidence in the safety of melatonin (4) barriers to prescribing and (5) future recommendations. The results showed that the perceived barriers to pharmacists’ safe supply of melatonin included time constraints, the need for supply of melatonin to be recorded and this data shared across pharmacies, as well as the need for dedicated education and training for pharmacists in sleep issues. However, despite these barriers, community pharmacists perceived themselves as suitable prescribers of melatonin, and that with appropriate education and training in insomnia and melatonin safety, their supply of melatonin could be expanded to include other age groups. Conclusion: Community pharmacists perceived themselves as being in an appropriate position to supply over the counter melatonin for patients aged 55 years and over. However, there is a need for expanded education and resources to enhance the confidence of community pharmacists in the identification of insomnia presentations and safe supply of melatonin.

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References

1. Roth T. Insomnia: definition, prevalence, etiology, and consequences. J Clin Sleep Med. 2007;3(5 Suppl): S7-10.
2. Bollu PC, Kaur H. Sleep Medicine: Insomnia and Sleep. Mo Med. 2019;116(1):68-75.
3. Medic G, Wille M, Hemels ME. Short- and long-term health consequences of sleep disruption. Nat Sci Sleep. 2017;9:151-161. doi:10.2147/NSS.S134864
4. Fernandez-Mendoza J, Vgontzas AN. Insomnia and its impact on physical and mental health. Curr Psychiatry Rep. 2013;15(12):418. doi:10.1007/s11920-013-0418-8
5. Insomnia in Adults. Therapeutic Guidelines. [accessed 14 April 2023].
6. Edinoff AN, Nix CA, Hollier J, Sagrera CE, Delacroix BM, Abubakar T, Cornett EM, Kaye AM, Kaye AD. Benzodiazepines: Uses, Dangers, and Clinical Considerations. Neurol Int. 2021;13(4):594-607. doi:10.3390/neurolint13040059
7. Holbrook AM, Crowther R, Lotter A, Cheng C, King D. Meta-analysis of benzodiazepine use in the treatment of insomnia. CMAJ. 2000;162(2):225-33.
8. Stewart SA. The effects of benzodiazepines on cognition. J Clin Psychiatry. 2005;66 Suppl 2:9-13.
9. Proposed changes to Required Advisory Statements for Medicine Labels (RASML): Melatonin. Therapeutic Goods Administration. [accessed 14 April 2023].
10. Zisapel N. New perspectives on the role of melatonin in human sleep, circadian rhythms and their regulation. Br J Pharmacol. 2018;175(16):3190-3199. doi:10.1111/bph.14116
11. Riemann, D, Espie CA, Altena E, Arnardottir ES, Baglioni C, Bassetti CLA, et al. The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023. J Sleep Res. 2023;32(6):e14035. doi:10.1111/jsr.14035
12. NHS. Taking melatonin with other medicines and herbal supplements. NHS. Updated 2024. Accessed April 2024, 2024. https:// www.nhs.uk/medicines/melatonin/taking-melatonin-with-other-medicines-and-herbal-supplements
13. Foley HM, Steel AE. Adverse events associated with oral administration of melatonin: A critical systematic review of clinical evidence. Complementary therapies in medicine. 2019;42:65-81.
14. Tuft C, Matar E, Menczel Schrire Z, Grunstein RR, Yee BJ, Hoyos CM. Current Insights into the Risks of Using Melatonin as a Treatment for Sleep Disorders in Older Adults. Clin Interv Aging. 2023;18:49-59. doi:10.2147/CIA.S361519
15. Strand MA, Bratberg J, Eukel H, Hardy M, Williams C. Community Pharmacists’ Contributions to Disease Management During the COVID-19 Pandemic. Prev Chronic Dis. 2020;17:E69. doi:10.5888/pcd17.200317
16. Irish LA, Kline CE, Gunn HE, Buysse DJ, Hall MH. The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep Med Rev. 2015;22:23-36. doi:10.1016/j.smrv.2014.10.001
17. Zurynski Y, Ansell J, Ellis LA, Pomare C, Smith CL, Holt J, Root J, Gillespie J, Wells L, Braithwaite J. Accessible and affordable healthcare? Views of Australians with and without chronic conditions. Intern Med J. 2021;51(7):1060-1067. doi:10.1111/ imj.15172
18. Kippist C, Wong K, Bartlett D, Saini B. How do pharmacists respond to complaints of acute insomnia? A simulated patient study. Int J Clin Pharm. 2011;33(2):237-45. doi:10.1007/s11096-011-9482-5
19. Yue JL, Chang XW, Zheng JW, Shi L, Xiang YJ, Que JY, Yuan K, Deng JH, Teng T, Li YY, Sun W, Sun HQ, Vitiello MV, Tang XD, Zhou XY, Bao YP, Shi J, Lu L. Efficacy and tolerability of pharmacological treatments for insomnia in adults: A systematic review and network meta-analysis. Sleep Med Rev. 2023;68:101746. doi:10.1016/j.smrv.2023.101746
20. Ashkanani FZ, Lindsey L, Rathbone AP. A systematic review and thematic synthesis exploring the role of pharmacists in supporting better sleep health and managing sleep disorders. Int J Pharm Pract. 2023;31(2):153-164. doi:10.1093/ijpp/riac102
21. Sundler AJ, Lindberg E, Nilsson C, Palmer L. Qualitative thematic analysis based on descriptive phenomenology. Nurs Open. 2019;6(3):733-739. doi:10.1002/nop2.275
22. Therapeutic Goods (Poisons Standard—February 2024) Instrument 2024 (Australian Government) (2024).
23. Hope DL, Day G, Clements J, Hattingh HL. Australian community pharmacists’ perceptions of public health before the COVID-19 pandemic. Int J Pharm Pract. 2021;29(3):291-295. doi:10.1093/ijpp/riaa010
24. Fuller JM, Wong KK, Hoyos C, Krass I, Saini B. Dispensing good sleep health behaviours not pills--a cluster-randomized controlled trial to test the feasibility and efficacy of pharmacist-provided brief behavioural treatment for insomnia. J Sleep Res. 2016;25(1):104-15. doi:10.1111/jsr.12328
25. Neubauer DN, Pandi-Perumal SR, Spence DW, Buttoo K, Monti JM. Pharmacotherapy of Insomnia. J Cent Nerv Syst Dis. 2018;10:1179573518770672. doi:10.1177/1179573518770672
26. The Poisons Standard (the SUSMP). Therapeutics Goods Administration. [accessed April 14 2023].
27. Schifano F, Chiappini S, Miuli A, Mosca A, Santovito MC, Corkery JM, Guirguis A, Pettorruso M, Di Giannantonio M, Martinotti G. Focus on Over-the-Counter Drugs’ Misuse: A Systematic Review on Antihistamines, Cough Medicines, and Decongestants. Front Psychiatry. 2021;12:657397. doi:10.3389/fpsyt.2021.657397
28. Abraham O, Schleiden L, Albert SM. Over-the-counter medications containing diphenhydramine and doxylamine used by older adults to improve sleep. Int J Clin Pharm. 2017;39(4):808-817. doi:10.1007/s11096-017-0467-x
29. Hanes CA, Wong KK, Saini B. Consolidating innovative practice models: The case for obstructive sleep apnea services in Australian pharmacies. Res Social Adm Pharm. 2015;11(3):412-27. doi:10.1016/j.sapharm.2014.08.009
30. Kosari S, Deeks LS, Naunton M, Dawda P, Postma MJ, Tay GH, Peterson GM. Funding pharmacists in general practice: A feasibility study to inform the design of future economic evaluations. Res Social Adm Pharm. 2021;17(5):1012-1016. doi:10.1016/j. sapharm.2020.07.030
31. Marriott J, Duncan G, Mc Namara K. Barriers to pharmacist participation in continuing education in Australia. 2023. https://dro.deakin.edu.au/articles/journal_contribution/Barriers_to_pharmacist_participation_in_continuing_education_in_Australia/20555565 [accessed 20 March 2007]