General practitioners’ preferences for managing insomnia and opportunities for reducing hypnotic prescribing A. Niroshan Siriwardena MMedSci PhD FRCGP, 1 Tanefa Apekey BSc MPhil, 2 Michelle Tilling, 3 Jane V. Dyas BSc MEd PhD PGDipHP, 4 Hugh Middleton MA MD MRCP MRCPsych 5 and Roderick Ørner BA MSc (ClinPsych) PhD 6 1 Foundation Professor of Primary Care, 6 Consultant Clinical Psychologist and Visiting Professor, Faculty of Health, Life & Social Sciences, University of Lincoln, Brayford Pool, Lincoln, UK 2 Research Assistant, 3 Project Manager, Research and Development, Lincolnshire Teaching Primary Care Trust, Cross O’Cliff Court, Bracebridge Heath, Lincoln, UK 4 Senior Research Fellow, National Institute for Health Research, Research Design Service East Midlands, Division of Primary Care, University Park, University of Nottingham, Nottingham, UK 5 Associate Professor, School of Sociology and Social Policy, University of Nottingham, University Park, Nottingham, UK Keywords attitude, cross-sectional studies, hypnotics and sedatives, insomnia, prescriptions Correspondence Professor A. Niroshan Siriwardena Faculty of Health, Life & Social Sciences University of Lincoln Brayford Pool Lincoln LN6 7TS UK E-mail: nsiriwardena@lincoln.ac.uk Accepted for publication: 3 December 2008 doi:10.1111/j.1365-2753.2009.01186.x Abstract Rationale, aims and objectives Insomnia 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. Methods Cross-sectional survey of GPs using a self-administered postal questionnaire in 2005 to all GPs in West Lincolnshire Primary Care Trust Lincolnshire, UK. Results A 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. Conclusions GPs were negative in attitude towards hypnotics and positive towards reduc- ing 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. Introduction Insomnia and sleep problems are common, affecting over a third of adults in the UK and the rest of Europe [1,2]. Many of those whose lives are affected seek medical help from general practitioners (GPs) [3] whose clinical response often involves prescription of hypnotic drugs. Despite a gradual fall in prescribing of benzodiazepines over the past decade the combined use of benzodiazepine hypnotics and newer Z drugs is on the rise both in terms of the number of items and total costs. Variations in prescribing rates between different GPs and across regions in the UK suggest that there is consider- able scope for changing clinical practice to one which does not rely so heavily on drugs. This is indicated not only for reasons of cost but also because of the limited therapeutic value of medication and the relative effectiveness of alternative management strategies. Previous research has documented the attitudes of patients and doctors to hypnotics [4–10] but has not explored the potential for reducing prescribing in this area. We have shown in a previous study that a prevalent view among GPs is that when Journal of Evaluation in Clinical Practice ISSN 1356-1294 © 2010 Blackwell Publishing Ltd, Journal of Evaluation in Clinical Practice 16 (2010) 731–737 731