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Cited by 71Sleep and related disordersPrimary Care and Health OutcomesPharmaceutical Practices and Patient Outcomes

Time trends in the family physician management of insomnia: The Australian experience (2000–2015)

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Miller, Christopher B., Valenti, Lisa, Harrison, Christopher M., Bartlett, Delwyn J., Glozier, Nick, Cross, Nathan E., Grunstein, Ronald R., Britt, Helena C., Marshall, Nathaniel S.·2017·Journal of Clinical Sleep Medicine
DOI 10.5664/jcsm.6616PMC PMC5443739
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Abstract

Study objectives To evaluate changes in rates of family physician (FP) management of insomnia in Australia from 2000-2015.Methods The Bettering the Evaluation And Care of Health (BEACH) program is a nationally representative cross-sectional survey of 1,000 newly randomly sampled family physicians' activity in Australia per year, who each record details of 100 consecutive patient encounters. This provided records of approximately 100,000 encounters each year. We identified all encounters with patients older than 15 years where insomnia or difficulty sleeping was managed and assessed trends in these encounters from 2000-2015.Results There was no change in the management rate of insomnia from 2000-2007 (1.54 per 100 encounters [95% confidence interval [CI]: 1.49-1.58]). This rate was lower from 2008-2015 (1.31 per 100 encounters [95% CI: 1.27-1.35]). There was no change in FP management: pharmacotherapy was used in approximately 90% of encounters; nonpharmacological advice was given at approximately 20%; and onward referral at approximately 1% of encounters. Prescription of temazepam changed from 54.6 [95% CI: 51.4-57.9] per 100 insomnia problems in 2000-2001 to 43.6 [95% CI: 40.1-47.0] in 2014-2015, whereas zolpidem increased steadily from introduction in 2000 to 14.6 [95% CI: 12.2-17.1] per 100 insomnia problems in 2006-2007, and then decreased to 7.3 [95% CI: 5.4-9.2] by 2014-2015.Conclusions Insomnia management frequency decreased after 2007 in conjunction with ecologically associated Australian media reporting of adverse effects linked to zolpidem use. Australian FPs remain reliant on pharmacotherapy for the management of insomnia.

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  • A lack of access to CBTi has resulted in the majority of insomnia sufferers receiving prescriptions for sedative-hypnotic medications as the initial and ongoing treatment.

    “a lack of access to CBTi has resulted in the majority of insomnia sufferers receiving prescriptions for sedative-hypnotic medications as the initial and ongoing treatment [12,13].”

    From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [12]

    The Results (Changes in Management Approaches; page unavailable) report medication use at approximately 90% of Australian family-physician insomnia management occasions. The Introduction describes limited CBT access, but the Discussion says only that unchanged management practices were possibly due to limited health-system capacity. The paper does not establish that lack of CBT access caused most insomnia sufferers to receive sedative-hypnotic prescriptions as both initial and ongoing treatment. (LLM, conf=0.87)

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Research works printed but not linked: 4

  1. [21]Marshall N, Glozier N, Grunstein RR. Thirty-fold spike in adverse event reporting associated with zolpidem use in Australia was most likely caused by the media. Sleep. 2009;32:A393. Abstract Suppl. [Google Scholar]
  2. [27]Charles J, Harrison C, Britt H. Insomnia. Aust Fam Physician. 2009;38(5):283. [PubMed] [Google Scholar]
  3. [38]WONCA International Classification Committee. International Classification of Primary Care: ICPC-2. 2nd ed. Oxford, England: Oxford University Press; 1998. [Google Scholar]
  4. [42]Kathol RG, Arnedt JT. Cognitive behavioral therapy for chronic insomnia: confronting the challenges to implementation. Ann Intern Med. 2016;165(2):149–150. doi: 10.7326/M16-0359. [DOI] [PubMed] [Google Scholar] · DOI

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Authors
Miller, C. B., Valenti, L., Harrison, C. M., Bartlett, D. J., Glozier, N., Cross, N. E., Grunstein, R. R., Britt, H. C., & Marshall, N. S.
Affiliations
The University of Sydney (AU)
Corresponding author
Marshall, Nathaniel S.
ORCID
Venue
Journal of Clinical Sleep Medicine
Publisher
Springer Science and Business Media LLC
Published
2017-06-15
Volume
13
Issue
6
Pages
785-790
ISSN
  • 1550-9389 (ISSN-L)
  • 1550-9397
DOI
10.5664/jcsm.6616
PMC
PMC5443739
OpenAlex
W2736916391
Cited by
71
References
26
Citations by year
2026: 6 · 2025: 12 · 2024: 11 · 2023: 8 · 2022: 7 · 2021: 11 · 2020: 5 · 2019: 7 · 2018: 3 · 2017: 1
FWCI
5.66
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Clinical Sleep Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords
insomnia, general practitioners, primary care management, prescribing patterns, temazepam, zolpidem, media coverage, temporal trends, Australia
MeSH terms
Adolescent, Adult, Aged, Australia, Cross-Sectional Studies, Female, Humans, Hypnotics and Sedatives, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Physicians, Family, Referral and Consultation, Time, Health Care Surveys, Young Adult

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