Patient Self-Guided Interventions to Reduce Sedative Use and Improve Sleep
JAMA Psychiatry,
Год журнала:
2024,
Номер
unknown
Опубликована: Сен. 18, 2024
Importance
Direct-to-patient
interventions
enabling
transitions
from
long-term
benzodiazepine
receptor
agonist
(BZRA)
use
to
cognitive
behavioral
therapy
for
insomnia
(CBTI)
by
older
adults
has
the
potential
reduce
BZRA
and
related
harms
while
improving
sleep
outcomes
without
requiring
prearranged
clinician
involvement.
Objective
To
compare
2
direct-to-patient
behavior
change
with
treatment
as
usual
(TAU)
on
use,
sleep,
other
health
outcomes,
uptake
of
CBTI
techniques.
Design,
Setting,
Participants
The
Your
Answers
When
Needing
Sleep
in
New
Brunswick
(YAWNS
NB)
study
was
a
3-arm,
pragmatic,
open-label,
minimum-contact,
randomized
clinical
trial.
began
November
2020
ended
June
2022.
were
randomly
allocated
1
3
groups,
including
different
mailed
or
no
intervention
(TAU).
communities
across
province
Brunswick,
Canada,
included
65
years
living
independently
BZRAs
current
past
insomnia.
Interventions
Sleepwell
package
(YAWNS-1)
consisted
cover
letter
booklets
(“How
Stop
Sleeping
Pills”
“How
Get
Back”).
(YAWNS-2)
updated
versions
(“You
May
Be
at
Risk”
Good
Night’s
Without
Medication”)
used
Eliminating
Medications
Through
Patient
Ownership
End
Results
(EMPOWER)
study.
Main
Outcomes
Measures
6
months
primary
measure.
Secondary
measures
insomnia,
daytime
sleepiness,
safety,
anxiety,
frailty,
quality
life.
A
total
1295
individuals
expressed
interest
study,
565
(43.6%)
completed
baseline
assessment.
had
mean
(SD)
age
72.1
(5.7)
years,
duration
11.4
(9.1)
362
(64.1%)
female.
Discontinuations
dose
reductions
25%
greater
highest
YAWNS-1
(50
191
[26.2%];
39
[20.4%];
total,
46.6%)
compared
YAWNS-2
(38
187
[20.3%];
27
[14.4%];
34.8%,
P
=
.02)
TAU
(14
[7.5%];
24
[12.8%];
20.3%,
<
.001).
also
demonstrated
better
techniques
(new
techniques:
3.1
vs
2.4;
=.03;
efficiency
change:
4.1%
−1.7%;
=.001)
reduced
severity
sleepiness
(insomnia
index
−2.0
0.3;
<.001;
Epworth
Sleepiness
Scale
−0.8
=.001).
Conclusions
Relevance
YAWNS
NB
trial
show
that,
simple,
scalable,
intervention,
substantially
improved
outcomes.
It
could
be
implemented
transform
care
population
level.
Trial
Registration
ClinicalTrials.gov
Identifier:
NCT04406103
Язык: Английский
General practitioners’ reflections on prescribing addictive hypnotics to elderly: a qualitative study
BJGP Open,
Год журнала:
2024,
Номер
unknown, С. BJGPO.2024.0157 - BJGPO.2024.0157
Опубликована: Июль 19, 2024
Background
The
European
guideline
for
the
diagnosis
and
treatment
of
insomnia
recommends,
all
age
groups,
only
restrictive,
short-term,
periodic
use
potentially
addictive
hypnotics.
As
in
other
countries,
Norway,
actual
practice
involving
older
patients
differs
substantially
from
this
recommendation,
as
shown
by
persistent
high
frequency
regular
prescriptions
Aim
To
explore
experienced
Norwegian
GPs’
views
prescription
hypnotics
to
aged
>70
years
living
at
home.
Design
&
setting
In-depth
individual
interviews
a
purposive
sample
specialists
family
medicine
GP
offices
Southern
Norway.
Method
used
semi-structured
interview
guide
were
performed
between
June
2022
January
2023.
Reflexive
thematic
cross-case
analysis
was
analyse
data.
Results
Most
11
GPs
interviewed
had
more
than
10
who
prescribed
daily
same
number
intermittent
prescription.
Almost
z-hypnotics.
knew
contrary
guideline.
Many
ease
with
fact.
They
emphasised
need
avoid
creating
new
dependencies.
considered
these
selected
minority
within
group
serious
sleep
problems,
whom
few
realistic
alternatives
available
whose
tolerance
over
time
better
expected.
This
logic
pragmatic
reflected
patient-centred
approach
respect
patient’s
view
shared
decision-making
process,
combined
challenges
limited
resources.
Conclusion
A
'zero
vision'
on
people
may
neither
be
prudent
nor
context
general
practice.
Язык: Английский