General practitioners' preferences for managing insomnia and opportunities for reducing hypnotic prescribing
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.
- SourceAvailable from: Janet MY Cheung
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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). "
ABSTRACT: Insomnia is a common sleep disorder associated with substantial direct and indirect costs, yet there is a strong propensity among patients to self-medicate which often delays professional help. Understanding the process which underpins the initiation, engagement and adherence to insomnia treatment(s) is a vital step for understanding this phenomenon. The current paper explores how the patient perspective has been conceptualized in the research literature and its implications for insomnia treatment and health care delivery. A literature search was conducted using Embase, Medline and PsycINFO databases. Articles have been thematically organized into patient correlates of health behaviors, patient experiences and treatment attitudes. Deferral of professional help among insomnia patients is partially related to barriers embedded in the health care system and patient health beliefs.Behavioral Sleep Medicine 06/2012; DOI:10.1080/15402002.2012.694382 · 1.56 Impact Factor
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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). "
ABSTRACT: The present study explored the applicability of two brief evidence-based interventions to improve sleep quality in inpatient psychiatry. The study involved three comparable admission wards of a psychiatric hospital. Stimulus control was introduced at the first ward, and music-assisted relaxation at the second. At the third ward, no intervention was introduced. A mixed-method study was employed. We found that nurses share the opinion that both interventions can be applied, but patients are hard to motivate. They perceived the lack of available time, busyness at the ward, and the lack of cooperation of patients as the main obstacles. The perception of a successful implementation is correlated with the perception of gained attention for sleep problems, the perception of increased care options, and the impression of effectiveness. Qualitative data showed that the effectiveness of the interventions was compromised by operational issues, commitment issues, adaptation to contextual limitations, and conflicting individual beliefs. We concluded that music-assisted relaxation is applicable in inpatient psychiatry. The application of stimulus control met with insurmountable operational issues. The nursing team is a very important factor for the implementation of evidence-based interventions at ward level. The lack of a shared urge for change and responsibility for continuity are important factors contributing to failure.International journal of mental health nursing 03/2011; 20(5):319-27. DOI:10.1111/j.1447-0349.2010.00733.x · 2.01 Impact Factor
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ABSTRACT: Insomnia affects around one-third of adults in the UK. Many sufferers seek help from primary care. To explore patients' and primary care practitioners' expectations, experiences, and outcomes of consultations for sleep difficulties, as a basis for improving the treatment of insomnia in primary care. A qualitative phenomenological approach. Separate focus groups for GPs and nurse prescribers and patients recruited from eight general practices that were in a quality improvement collaborative. Constant comparative analysis was used. Emergent themes from 14 focus groups comparing participating patients (n = 30) and practitioners (n = 15), provided insights on presentation, beliefs, expectations, and management of sleep problems. Patients initially tried to resolve insomnia themselves; consulting was often a last resort. Patients felt they needed to convince practitioners that their sleep difficulties were serious. They described insomnia in terms of the impact it was having on their life, whereas clinicians tended to focus on underlying causes. By the time patients consulted, many expected a prescription. Clinicians often assumed this was what patients wanted, and felt this would hamper patients' ability to take non-drug treatments seriously. Clinicians expected patients who were already on sleeping tablets to be resistant to stopping them, whereas patients were often open to alternatives. Better management of insomnia should take into account the perceptions and interactions of patients and practitioners. Practitioners need to empathise, listen, elicit patients' beliefs and expectations, assess sleep better, and offer a range of treatments, including cognitive and behavioural therapies, tailored to individual needs. Practitioner education should incorporate understanding of patients' decision-making processes, the clinicians' role during the consultation, and how to negotiate and deliver strategies for resolving sleep problems.British Journal of General Practice 05/2010; 60(574):e180-200. DOI:10.3399/bjgp10X484183 · 2.36 Impact Factor