Management of sleep disorder by preceptors in a family medicine residency program in Calgary, Alberta: a mixed-methods study

BACKGROUND: Most prescriptions for sedative–hypnotics are written by family physicians. Given the influence of preceptors on residents’ prescribing, this study explored how family physician preceptors manage sleeping problems. METHODS: Family physician preceptors affiliated with a postgraduate training program in Alberta were invited to participate in this mixed-methods study, conducted from January to October 2021. It included a quantitative survey of preceptors’ attitudes to treatment options for sleep disorder, perceptions of patient expectations and self-efficacy beliefs. Participants indicated their responses on a 5-point Likert scale ranging from “strongly disagree” to “strongly agree.” Respondents were then asked whether they were interested in participating in a semistructured qualitative interview that elicited preceptors’ management of sleep disorder in response to a series of vignettes. We analyzed the quantitative data using descriptive statistics and the qualitative interviews using thematic analysis. RESULTS: Of the 76 preceptors invited to participate, 47 (62%) completed the survey, and 10 were interviewed. Thirty-two survey respondents (68%) were in academic teaching clinics, and 15 (32%) were from community clinics. The majority of participants (34 [72%]) agreed they had sufficient expertise to use nondrug treatment. Most (43 [91%]) had made efforts to reduce prescribing, and 45 (96%) felt able to support patients empathically when not using sleeping medication. The qualitative data showed that management of sleeping disorder was emotionally challenging. Participants hesitated to prescribe sedatives and reported “exceptions” to prescribing, many of which included indications within guideline recommendations. Participants were reluctant to change a colleague’s management. INTERPRETATION: Preceptors were confident using nonpharmacologic management to treat sleep disorder and hesitant to use sedative–hypnotics, presenting legitimate use of sedatives as exceptional behaviour. Acknowledging social norms and affective aspects involved in prescribing may support balanced prescribing of sedative–hypnotics for sleep disorder and reduce physician anxiety.