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Patient experiences of a quality improvement initiative to reduce inappropriate long term hypnotic prescribing in a rural practice

机译:质量改进计划的患者经验,以减少农村实践中不适当的长期催眠处方

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摘要

IntroductionudInsomnia is common affecting up to 40% of adults. About a half of sufferers seek help from primary care, usually receiving sleep hygiene advice or hypnotic medication. Hypnotics are licensed short term, have limited therapeutic value and significant potential adverse effects, but many patients continue to receive them long term inappropriately. An innovative sleep management programme to reduce inappropriate prescribing of hypnotics was implemented by a single general practice in rural Lincolnshire as part of a quality improvement collaborative. This involved gradual withdrawal of hypnotic drugs supported by sleep assessment and treatment using cognitive behavioural therapy for insomnia. Little is known about patients’ experience of this type of withdrawal programme. We aimed to investigate patients’ experiences.ududMethodudWe used a focus group interview to investigate patients’ experiences of the programme, inviting patients who had undergone the programme by letter. The focus group was moderated by two independent non-clinical researchers using a topic guide. Data were recorded, transcribed and analysed using a constant comparative approach using MAXQDA 2007.ududResultsudA single focus group was held with four patients. Key themes that emerged included current feelings about sleeping tablets, attitudes towards the process, access to GP support, perceived usefulness of sleep management, (re)attribution of sleep difficulty and current quality of patients’ sleep. Although patients were initially ambivalent they followed the programme because of trust in their doctor and a clear and consistent approach from the practice. Patients expressed a need for more face-to-face sleep advice during the process and greater recognition afterwards. They were generally positive about the benefits of hypnotic withdrawal despite variable effects on sleep. ududDiscussion udPatients were positive about the benefits of withdrawing from long term hypnotic drugs. They made recommendations about future programmes. Sleep education should be delivered during a consultation and a formal end to the process, recognising the patients’ success, should be incorporated. The main limitation was that the focus group was conducted over a year after the sleep management programme was conducted which may have affected participation. Focus groups can provide a useful method of evaluating patients’ experience which is an important aspect of quality of care.
机译:简介 ud失眠是常见的疾病,最多可影响40%的成年人。大约一半的患者寻求初级保健的帮助,通常会接受睡眠卫生建议或催眠药。催眠药是短期许可的,具有有限的治疗价值和明显​​的潜在不良反应,但许多患者长期不适当地继续接受催眠药。作为一项质量改进合作计划的一部分,林肯郡农村地区的一项常规做法实施了一项创新的睡眠管理计划,以减少催眠药的不当处方。这涉及逐步停用催眠药,并通过睡眠评估和使用认知行为疗法治疗失眠症进行治疗。病人对这种戒断计划的经验知之甚少。我们旨在调查患者的经历。 ud udMethod ud我们使用焦点小组访谈来调查患者对该计划的经历,以信函方式邀请接受过该计划的患者。焦点小组由两名独立的非临床研究人员使用主题指南进行主持。使用恒定比较方法使用MAXQDA 2007记录,转录和分析数据。 ud udResults ud由四个患者组成一个焦点小组。出现的主要主题包括当前对睡眠药片的感觉,对过程的态度,获得全科医生支持,对睡眠管理的有用感觉,睡眠困难的(重新)归因和患者目前的睡眠质量。尽管患者最初是矛盾的,但由于对医生的信任以及实践中明确而一致的方法,他们仍遵循该计划。患者表示在此过程中需要更多的面对面睡眠建议,之后需要更多的认可。尽管对睡眠有多种影响,但他们对催眠戒断的益处总体上是积极的。 ud ud讨论 ud患者对长期服用催眠药的益处持肯定态度。他们提出了有关未来计划的建议。应当在会诊期间进行睡眠教育,并应正式承认这一过程,以承认患者的成功为目标。主要限制是焦点小组是在实施睡眠管理计划后的一年内进行的,这可能会影响参与。焦点小组可以提供一种评估患者经验的有用方法,这是护理质量的重要方面。

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