General practitioners' preferences for managing insomnia and opportunities for reducing hypnotic prescribing

Journal of Evaluation in Clinical Practice (Impact Factor: 1.58). 06/2010; 16(4):731 - 737. DOI: 10.1111/j.1365-2753.2009.01186.x

ABSTRACT Rationale, aims and objectives Insomnia and sleep problems are common with many sufferers seeking medical help from general practitioners (GPs) whose clinical response is limited, often involving prescription of hypnotic drugs. The case for improving the quality of care for patients with insomnia is compelling but there is little evidence about how better care could be achieved in a primary care setting. The aim of this study was to investigate GPs' management preferences for sleep problems and their awareness and perception of opportunities for improving care as well as reducing the use of benzodiazepines and Z drugs.
Methods Cross-sectional survey of GPs using a self-administered postal questionnaire in 2005 to all GPs in West Lincolnshire Primary Care Trust Lincolnshire, UK.
Results A total of 84 of 107 (78.5%) questionnaires sent to GP principals were returned after one reminder. Respondents favoured Z drugs over benzodiazepines for the majority of indications. Respondent attitudes to benzodiazepines and Z drugs were generally negative whereas they were positive towards initiatives to reduce hypnotic prescribing through personal guidance, awareness-raising strategies and organizational interventions.
Conclusions GPs were negative in attitude towards hypnotics and positive towards reducing prescribing for sleep problems. They need to develop resources and better strategies for assessment and non-pharmacological management of patients presenting with insomnia for the first time as well as those on long-term hypnotics. The feasibility and effectiveness of psychosocial interventions tailored to patient and service needs in primary care setting should be evaluated systematically seeking to understand potential clinical benefits as well as potential undesirable effects of service changes.

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    • "One such obstacle relates to physicianassumed patient preferences. While physicians do understand the merits of reducing hypnotic prescriptions they assume that a vast majority of patients would prefer a hypnotic " quick fix " (Siriwardena et al., 2010). This contributes to an underlying pressure for physicians to continuously prescribe these medications (Dyas et al., 2010; Mah & Upshur, 2002). "
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    • "The common treatment of insomnia complaints, that is, treating insomnia with hypnotics, such as benzodiazepines , is under serious discussion among general practitioners (Siriwardena et al. 2010). Benzodiazepines are known to have major disadvantages, such as dependency, decreasing efficiency, and safety-threatening daytime sedation (Kripke 2000). "
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