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GPs' management strategies for patients with insomnia: a survey and qualitative interview study

GPs' management strategies for patients with insomnia: a survey and qualitative interview study
GPs' management strategies for patients with insomnia: a survey and qualitative interview study
Background

Patients frequently experience sleep problems and present to primary care. However, information is limited regarding the management strategies that GPs employ.

Aim

To gain an understanding of current GP management strategies for insomnia.

Design and setting

A postal questionnaire survey and qualitative interviews with GPs in the south of England.

Method

A postal survey of 296 GPs and qualitative interviews were carried out with 23 of the GPs.

Results

The survey response rate was 56% (166/296). GPs look for signs of depression and anxiety in patients and if present treat these first. ‘Sleep hygiene’ advice is provided by 88% (147/166) of GPs but often seems insufficient and they feel under pressure to prescribe. Benzodiazepines and Z drugs are prescribed, often reluctantly, for short periods, because of known problems with dependence and tolerance. Many GPs prescribe low-dose amitriptyline for insomnia although it is not licensed for this indication. For insomnia 95% (157/166) of survey responders ‘ever prescribe’ amitriptyline, with 31% (52/166) stating they do so commonly. Most GPs perceived amitriptyline to be effective and a longer-term option for those with ongoing sleep problems. GPs report a lack of knowledge and confidence in the provision and use of psychological therapies, such as cognitive behavioural therapy (CBT), in the management of insomnia.

Conclusion

GPs often find ‘sleep hygiene’ advice is insufficient for managing insomnia and report frequently prescribing medication, including amitriptyline (off licence), which is often based on perceived patient pressure for a prescription. Patients are rarely offered psychological therapies such as CBT for insomnia, despite evidence suggesting its potential effectiveness.
amitriptyline, general practice, insomnia, management strategies
0960-1643
e112-e119
Everitt, Hazel
80b9452f-9632-45a8-b017-ceeeee6971ef
McDermott, Lisa
5e895229-decd-4a30-8d08-dd9cc5b8f443
Leydon, Geraldine
c5cdaff5-0fa1-4d38-b575-b97c2892ec40
Yules, Harvey
b4cc85be-69aa-4600-9de1-86c90564dd95
Baldwin, David
1beaa192-0ef1-4914-897a-3a49fc2ed15e
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Everitt, Hazel
80b9452f-9632-45a8-b017-ceeeee6971ef
McDermott, Lisa
5e895229-decd-4a30-8d08-dd9cc5b8f443
Leydon, Geraldine
c5cdaff5-0fa1-4d38-b575-b97c2892ec40
Yules, Harvey
b4cc85be-69aa-4600-9de1-86c90564dd95
Baldwin, David
1beaa192-0ef1-4914-897a-3a49fc2ed15e
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777

Everitt, Hazel, McDermott, Lisa, Leydon, Geraldine, Yules, Harvey, Baldwin, David and Little, Paul (2014) GPs' management strategies for patients with insomnia: a survey and qualitative interview study. British Journal of General Practice, 64 (619), e112-e119. (doi:10.3399/bjgp14X677176).

Record type: Article

Abstract

Background

Patients frequently experience sleep problems and present to primary care. However, information is limited regarding the management strategies that GPs employ.

Aim

To gain an understanding of current GP management strategies for insomnia.

Design and setting

A postal questionnaire survey and qualitative interviews with GPs in the south of England.

Method

A postal survey of 296 GPs and qualitative interviews were carried out with 23 of the GPs.

Results

The survey response rate was 56% (166/296). GPs look for signs of depression and anxiety in patients and if present treat these first. ‘Sleep hygiene’ advice is provided by 88% (147/166) of GPs but often seems insufficient and they feel under pressure to prescribe. Benzodiazepines and Z drugs are prescribed, often reluctantly, for short periods, because of known problems with dependence and tolerance. Many GPs prescribe low-dose amitriptyline for insomnia although it is not licensed for this indication. For insomnia 95% (157/166) of survey responders ‘ever prescribe’ amitriptyline, with 31% (52/166) stating they do so commonly. Most GPs perceived amitriptyline to be effective and a longer-term option for those with ongoing sleep problems. GPs report a lack of knowledge and confidence in the provision and use of psychological therapies, such as cognitive behavioural therapy (CBT), in the management of insomnia.

Conclusion

GPs often find ‘sleep hygiene’ advice is insufficient for managing insomnia and report frequently prescribing medication, including amitriptyline (off licence), which is often based on perceived patient pressure for a prescription. Patients are rarely offered psychological therapies such as CBT for insomnia, despite evidence suggesting its potential effectiveness.

Full text not available from this repository.

More information

e-pub ahead of print date: 27 January 2014
Published date: 1 February 2014
Keywords: amitriptyline, general practice, insomnia, management strategies
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 361632
URI: https://eprints.soton.ac.uk/id/eprint/361632
ISSN: 0960-1643
PURE UUID: 414c6dda-184b-4983-8d1d-74087aca9c81
ORCID for Hazel Everitt: ORCID iD orcid.org/0000-0001-7362-8403
ORCID for Geraldine Leydon: ORCID iD orcid.org/0000-0001-5986-3300

Catalogue record

Date deposited: 28 Jan 2014 15:16
Last modified: 17 Sep 2019 01:02

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