GPs' reflections on prescribing addictive hypnotics to older people: a qualitative study.

IF 2.5 Q2 PRIMARY HEALTH CARE BJGP Open Pub Date : 2024-10-29 DOI:10.3399/BJGPO.2024.0157
Holgeir Skjeie, Mette Brekke, Trygve Skonnord
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Abstract

Background: The European guideline for the diagnosis and treatment of insomnia recommends, for all age groups, only restrictive, short-term, and periodic use of potentially addictive hypnotics. As in other European countries, in Norway, actual practice involving older patients differs substantially from this recommendation, as shown by the persistent high frequency of regular prescriptions of addictive hypnotics.

Aim: To explore experienced Norwegian GPs' views of the regular prescription of addictive hypnotics to patients aged >70 years living at home.

Design & setting: In-depth individual interviews of a purposive sample of experienced specialists in family medicine at GP offices in Southern Norway.

Method: The interviews used a semi-structured interview guide and were performed between June 2022 and January 2023. Reflexive thematic cross-case analysis was used to analyse the data.

Results: Most of the 11 GPs interviewed had more than 10 older patients who were prescribed hypnotics for daily use and the same number for intermittent prescription. Almost all prescriptions were of z-hypnotics. The GPs knew this was contrary to the guideline. Many were at ease with this fact. They emphasised the need to avoid creating new dependencies. The GPs considered these patients a selected minority within this age group with serious sleep problems, for whom few realistic alternatives were available and whose tolerance over time was better than expected. This logic of pragmatic practice reflected a patient-centred approach and respect for the patient's view in a shared decision-making process, combined with challenges of limited alternatives and resources.

Conclusion: A 'zero vision' on the prescription of addictive hypnotics to older people may neither be prudent nor realistic in the context of general practice.

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全科医生对向老年人开具成瘾性催眠药的反思:一项定性研究。
背景:欧洲失眠症诊断和治疗指南》建议对所有年龄组的患者限制性地、短期地和定期地使用可能成瘾的催眠药。目的:探讨经验丰富的挪威全科医生(GPs)对为70岁以上居家老年人定期开具成瘾性催眠药处方的看法:对挪威南部全科医生办公室中经验丰富的家庭医学专家进行有目的的个人深度访谈:方法:反思性专题交叉案例分析:结果:在接受访谈的 11 名全科医生中,大多数都有 10 名以上的老年患者被开具日常使用的催眠药处方,也有相同数量的患者被开具间歇性处方。几乎所有处方都是z-催眠药。全科医生知道这违反了指南。许多全科医生对这一事实很坦然。他们强调需要避免产生新的依赖性。全科医生认为,这些患者是这一年龄组中经过挑选的少数人,他们有严重的睡眠问题,几乎没有现实的替代药物可供选择,而且随着时间的推移,他们的耐受性比预期的要好。这种务实的实践逻辑反映了一种以病人为中心的方法,在共同决策过程中尊重病人的意见,同时也面临着替代品和资源有限的挑战:结论:在全科实践中,对老年人处方成瘾性催眠药采取零容忍的态度可能既不谨慎也不现实。
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来源期刊
BJGP Open
BJGP Open Medicine-Family Practice
CiteScore
5.00
自引率
0.00%
发文量
181
审稿时长
22 weeks
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