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

Abstract

Introduction Insomnia 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. Method We 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. Results A 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. Discussion Patients 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