Primary care management of chronic insomnia: a qualitative analysis of the attitudes and experiences of Australian general practitioners.

Publisher: BioMed Central Country of Publication: England NLM ID: 100967792 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2296 (Electronic) Linking ISSN: 14712296 NLM ISO Abbreviation: BMC Fam Pract Subsets: MEDLINE

Original Publication: London : BioMed Central, [2000-2021]

General Practitioners* ; Sleep Initiation and Maintenance Disorders*/therapy; Adult ; Attitude of Health Personnel ; Australia ; Humans ; Primary Health Care ; Qualitative 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.
(© 2021. The Author(s).)

Aust J Prim Health. 2014;20(1):103-12. (PMID: 24200195)
Health Expect. 2015 Oct;18(5):1371-83. (PMID: 23952603)
Sleep. 2009 Dec;32(12):1549-58. (PMID: 20041590)
Behav Sleep Med. 2010;8(3):123-40. (PMID: 20582756)
BMJ. 2005 Nov 19;331(7526):1169. (PMID: 16284208)
Behav Sleep Med. 2012 Oct;10(4):266-79. (PMID: 22946736)
JMIR Mhealth Uhealth. 2020 Jun 1;8(6):e16497. (PMID: 32478660)
Qual Health Res. 2001 Jul;11(4):522-37. (PMID: 11521609)
Sleep Med. 2017 Aug;36 Suppl 1:S43-S47. (PMID: 28648226)
J Sleep Res. 2021 Feb;30(1):e13169. (PMID: 32951295)
J Clin Sleep Med. 2017 Aug 15;13(8):991-999. (PMID: 28728623)
Sleep Med. 2009 Apr;10(4):427-38. (PMID: 18753000)
Behav Sleep Med. 2019 Jan-Feb;17(1):19-30. (PMID: 28098492)
Int Rev Psychiatry. 2014 Apr;26(2):155-76. (PMID: 24892892)
J Am Geriatr Soc. 2012 Oct;60(10):1803-10. (PMID: 23035962)
JAMA. 2009 May 20;301(19):2005-15. (PMID: 19454639)
J Sleep Res. 2016 Feb;25(1):104-15. (PMID: 26306418)
Aust J Gen Pract. 2021 May;50(5):287-293. (PMID: 33928277)
Br J Gen Pract. 2014 Feb;64(619):e112-9. (PMID: 24567616)
J Psychopharmacol. 2019 Aug;33(8):923-947. (PMID: 31271339)
Fam Pract. 2018 Jul 23;35(4):365-375. (PMID: 29194467)
BMC Fam Pract. 2013 Dec 13;14:191. (PMID: 24330388)
Ann Intern Med. 2016 Jul 19;165(2):125-33. (PMID: 27136449)
Implement Sci Commun. 2020 Nov 30;1(1):107. (PMID: 33292865)
J Clin Sleep Med. 2017 Jun 15;13(6):785-790. (PMID: 28454597)
J Clin Sleep Med. 2008 Oct 15;4(5):487-504. (PMID: 18853708)
Curr Psychiatry Rep. 2013 Dec;15(12):418. (PMID: 24189774)
Lancet. 2012 Mar 24;379(9821):1129-41. (PMID: 22265700)
Contemp Nurse. 2005 Jul-Aug;19(1-2):75-87. (PMID: 16167437)
NIH Consens State Sci Statements. 2005 Jun 13-15;22(2):1-30. (PMID: 17308547)
Implement Sci. 2016 Mar 22;11:40. (PMID: 27001107)
Qual Quant. 2018;52(4):1893-1907. (PMID: 29937585)
Sleep Med Rev. 2021 Apr;56:101404. (PMID: 33370637)

Keywords: Australia; Family practice; General practice; General practitioners; Insomnia; Primary care; Qualitative research; Sleep

Date Created: 20210723 Date Completed: 20210924 Latest Revision: 20210924

20240829

PMC8299615

10.1186/s12875-021-01510-z

34294049