General practitioners' preferences for managing insomnia and opportunities for reducing hypnotic prescribing
General practitioners' preferences for managing insomnia and opportunities for reducing hypnotic prescribing
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DOI：
10.1111/j.1365-2753.2009.01186.x
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发表时间：
2010-08-01
影响因子：
2.4
通讯作者：
Orner, Roderick
中科院分区：
文献类型：
--
作者：
Siriwardena, A. Niroshan;Apekey, Tanefa;Orner, Roderick
基本原理、目的和目的失眠和睡眠问题是许多患者寻求全科医生（gp）的医疗帮助的常见问题，他们的临床反应有限，通常涉及催眠药物的处方。改善失眠症患者护理质量的案例是令人信服的，但几乎没有证据表明如何在初级保健环境中实现更好的护理。本研究的目的是调查全科医生对睡眠问题的管理偏好，以及他们对改善护理机会的认识和感知，以及减少苯二氮卓类药物和Z类药物的使用。方法2005年对英国林肯郡西林肯郡初级保健信托机构的全科医生进行问卷调查。结果向全科医院校长发放问卷107份，经1次催收后回收84份，占78.5%。在大多数适应症中，应答者更喜欢Z类药物而不是苯二氮卓类药物。受访者对苯二氮卓类药物和Z类药物的态度总体上是消极的，而他们对通过个人指导、提高认识战略和组织干预来减少催眠处方的举措持积极态度。结论全科医生对催眠药物的态度是消极的，对减少处方睡眠问题的态度是积极的。他们需要开发资源和更好的策略来评估和非药物管理首次出现失眠的患者以及长期催眠的患者。针对初级保健环境中患者和服务需求量身定制的社会心理干预措施的可行性和有效性应进行系统评估，以了解潜在的临床益处以及服务变化的潜在不良影响。
Rationale, aims and objectivesInsomnia 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.MethodsCross-sectional survey of GPs using a self-administered postal questionnaire in 2005 to all GPs in West Lincolnshire Primary Care Trust Lincolnshire, UK.ResultsA 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.ConclusionsGPs 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.