Exploring the pharmacist role in insomnia management and care provision: A scoping review

Background: Insomnia is a highly burdensome sleep disorder, with a global prevalence of approximately 30% in adults. Insomnia has negative effects on daily functioning and can play a pivotal role in the development and progression of comorbid mental and physical disease. Therefore, appropriate and timely management is essential. Pharmacists are at the forefront of the primary care workforce and given their expanding roles in care provision, would be able to alleviate the burden of insomnia in the community by delivering evidence-based management.

Objectives: To describe the current practice and potential roles of pharmacists in insomnia management.

Methods: The PRISMA-ScR guidelines were followed in this scoping exercise. An extensive search of five databases (MEDLINE, Embase, Scopus, IPA, CINAHL) was conducted, generating 1,057 initial results. Titles, abstracts, and full-text articles were screened in a two-step process to identify relevant studies for review inclusion. Studies reporting on insomnia management by pharmacists in primary care settings were included in the review. Articles were reviewed and data extracted, analyzed, and grouped categorically based on study design.

Results: Twenty-eight studies met inclusion criteria with 5 qualitative, 8 observational and 15 interventional studies. Over a third of the studies were conducted in Australia (n=11). Insomnia management across these studies ranged from 1) screening/assessment services (n=5), 2) pharmacological and non-pharmacological care provision (n=16), and 3) sedative-hypnotic deprescribing services (n=7). It was evident that pharmacological approaches remain the most common treatment modality adopted despite guidelines recommending cognitive behavioral therapy as first-line. The results show that with adequate training and education, pharmacists have the potential to provide insomnia screening, behavioral therapy, and pharmacological deprescribing services, improving overall insomnia management in primary care.

Conclusion: The outcomes of this review highlight a current gap in insomnia management practices carried out by pharmacists and provide evidence for expanded roles and improved care provision when pharmacists are upskilled with specialized training/education.