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Primary care management of chronic insomnia: a qualitative analysis of the attitudes and experiences of Australian general practitioners
BACKGROUND: Chronic insomnia is a highly prevalent disorder, with ten to thirty percent of Australian adults reporting chronic difficulties falling asleep and/or staying asleep such that it causes significant daytime impairment. Current Australian general practice guidelines recommend cognitive beha...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8299615/ https://www.ncbi.nlm.nih.gov/pubmed/34294049 http://dx.doi.org/10.1186/s12875-021-01510-z |
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author | Haycock, Jenny Grivell, Nicole Redman, Anne Saini, Bandana Vakulin, Andrew Lack, Leon Lovato, Nicole Sweetman, Alexander Zwar, Nicholas Stocks, Nigel Frank, Oliver Mukherjee, Sutapa Adams, Robert McEvoy, R. Doug Hoon, Elizabeth |
author_facet | Haycock, Jenny Grivell, Nicole Redman, Anne Saini, Bandana Vakulin, Andrew Lack, Leon Lovato, Nicole Sweetman, Alexander Zwar, Nicholas Stocks, Nigel Frank, Oliver Mukherjee, Sutapa Adams, Robert McEvoy, R. Doug Hoon, Elizabeth |
author_sort | Haycock, Jenny |
collection | PubMed |
description | BACKGROUND: Chronic insomnia is a highly prevalent disorder, with ten to thirty percent of Australian adults reporting chronic difficulties falling asleep and/or staying asleep such that it causes significant daytime impairment. Current Australian general practice guidelines recommend cognitive behavioural therapy for insomnia (CBTi) as first line treatment for insomnia, however research suggests that most general practice consultations for insomnia result in a prescription for hypnotic or sedative medicines. Although the first point of contact for patients experiencing symptoms of insomnia is often general practice, little is known about the current role, experiences and capacity of Australian general practitioners to manage insomnia. This study aimed to address that gap by exploring the attitudes and opinions of general practitioners regarding insomnia management, to inform the development and implementation of new models of best practice insomnia care within general practice. METHODS: A descriptive, pragmatic qualitative study. Purposive sampling was used to recruit practising Australian general practitioners, varying in age, years of experience and geographic location. Semi-structured interviews were conducted, and data analysed using thematic analysis. RESULTS: Twenty-eight general practitioners participated in the study. Three major themes were identified: 1) Responsibility for insomnia care; 2) Complexities in managing insomnia; and 3) Navigating treatment pathways. Whilst general practitioners readily accepted responsibility for the management of insomnia, provision of care was often demanding and difficult within the funding and time constraints of general practice. Patients presenting with comorbid mental health conditions and insomnia, and decision-making regarding long-term use of benzodiazepines presented challenges for general practitioners. Whilst general practitioners confidently provided sleep hygiene education to patients, their knowledge and experience of CBTi, and access and understanding of specialised referral pathways for insomnia was limited. CONCLUSIONS: General practitioners report that whilst assessing and managing insomnia can be demanding, it is an integral part of general practice. Insomnia presents complexities for general practitioners. Greater clarity about funding options, targeted education about effective insomnia treatments, and referral pathways to specialist services, such as benzodiazepine withdrawal support and psychologists, would benefit insomnia management within general practice. |
format | Online Article Text |
id | pubmed-8299615 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-82996152021-07-28 Primary care management of chronic insomnia: a qualitative analysis of the attitudes and experiences of Australian general practitioners Haycock, Jenny Grivell, Nicole Redman, Anne Saini, Bandana Vakulin, Andrew Lack, Leon Lovato, Nicole Sweetman, Alexander Zwar, Nicholas Stocks, Nigel Frank, Oliver Mukherjee, Sutapa Adams, Robert McEvoy, R. Doug Hoon, Elizabeth BMC Fam Pract Research BACKGROUND: Chronic insomnia is a highly prevalent disorder, with ten to thirty percent of Australian adults reporting chronic difficulties falling asleep and/or staying asleep such that it causes significant daytime impairment. Current Australian general practice guidelines recommend cognitive behavioural therapy for insomnia (CBTi) as first line treatment for insomnia, however research suggests that most general practice consultations for insomnia result in a prescription for hypnotic or sedative medicines. Although the first point of contact for patients experiencing symptoms of insomnia is often general practice, little is known about the current role, experiences and capacity of Australian general practitioners to manage insomnia. This study aimed to address that gap by exploring the attitudes and opinions of general practitioners regarding insomnia management, to inform the development and implementation of new models of best practice insomnia care within general practice. METHODS: A descriptive, pragmatic qualitative study. Purposive sampling was used to recruit practising Australian general practitioners, varying in age, years of experience and geographic location. Semi-structured interviews were conducted, and data analysed using thematic analysis. RESULTS: Twenty-eight general practitioners participated in the study. Three major themes were identified: 1) Responsibility for insomnia care; 2) Complexities in managing insomnia; and 3) Navigating treatment pathways. Whilst general practitioners readily accepted responsibility for the management of insomnia, provision of care was often demanding and difficult within the funding and time constraints of general practice. Patients presenting with comorbid mental health conditions and insomnia, and decision-making regarding long-term use of benzodiazepines presented challenges for general practitioners. Whilst general practitioners confidently provided sleep hygiene education to patients, their knowledge and experience of CBTi, and access and understanding of specialised referral pathways for insomnia was limited. CONCLUSIONS: General practitioners report that whilst assessing and managing insomnia can be demanding, it is an integral part of general practice. Insomnia presents complexities for general practitioners. Greater clarity about funding options, targeted education about effective insomnia treatments, and referral pathways to specialist services, such as benzodiazepine withdrawal support and psychologists, would benefit insomnia management within general practice. BioMed Central 2021-07-22 /pmc/articles/PMC8299615/ /pubmed/34294049 http://dx.doi.org/10.1186/s12875-021-01510-z Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Haycock, Jenny Grivell, Nicole Redman, Anne Saini, Bandana Vakulin, Andrew Lack, Leon Lovato, Nicole Sweetman, Alexander Zwar, Nicholas Stocks, Nigel Frank, Oliver Mukherjee, Sutapa Adams, Robert McEvoy, R. Doug Hoon, Elizabeth Primary care management of chronic insomnia: a qualitative analysis of the attitudes and experiences of Australian general practitioners |
title | Primary care management of chronic insomnia: a qualitative analysis of the attitudes and experiences of Australian general practitioners |
title_full | Primary care management of chronic insomnia: a qualitative analysis of the attitudes and experiences of Australian general practitioners |
title_fullStr | Primary care management of chronic insomnia: a qualitative analysis of the attitudes and experiences of Australian general practitioners |
title_full_unstemmed | Primary care management of chronic insomnia: a qualitative analysis of the attitudes and experiences of Australian general practitioners |
title_short | Primary care management of chronic insomnia: a qualitative analysis of the attitudes and experiences of Australian general practitioners |
title_sort | primary care management of chronic insomnia: a qualitative analysis of the attitudes and experiences of australian general practitioners |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8299615/ https://www.ncbi.nlm.nih.gov/pubmed/34294049 http://dx.doi.org/10.1186/s12875-021-01510-z |
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