A systematic review of regulatory and educational interventions to reduce the burden associated with the prescriptions of sedative-hypnotics in adults treated for sleep disorders

<div><p>Background</p><p>The burden of Sedative-Hypnotics (SHs) has been known since the 1980s. Yet, their consumption remains high. A systematic review of the literature should help to assess efficient interventions to improve the appropriate use of SHs in sleep disorders.</p><p>Objectives</p><p>To identify and assess regulatory and educational interventions designed to improve the appropriate use of SHs for insomnia treatment.</p><p>Methods</p><p>We conducted a systematic review of the literature according to PRISMA guidelines. A systematic search covering the period 1980–2015 was carried out in Medline, Web of Science, Embase and PsycInfo. We included studies reporting the implementation of regulatory or educational strategies directed towards patients and/or healthcare professionals to improve the appropriate use of SHs to treat insomnia in the community, hospitals and nursing homes.</p><p>Results</p><p>Thirty-one studies were included: 23 assessed educational interventions (recommendations by mail/email, computer alerts, meetings, mass media campaigns, prescription profile), 8 assessed regulatory interventions (prescription rule restriction, end of reimbursement). The most recent was implemented in 2009. Restrictive prescription rules were effective to reduce the consumption of targeted SHs but led to a switch to other non-recommended SHs. Among educational interventions, only 3 studies out of 7 reported positive results of mono-faceted interventions; whereas, 13 out of the 16 multi-faceted interventions were reported as efficient: particularly, the active involvement of healthcare professionals and patients and the spread of information through mass media were successful. The risk of bias was high for 24 studies (mainly due to the design), moderate for 3 studies and weak for 4 studies.</p><p>Conclusion</p><p>Educational multifaceted studies are presented as the most efficient. But further better designed studies are needed to make evidence-based results more generalizable.</p></div

Representation of study results as a function of study design, type of intervention and risk of bias.

<p>Bold text: Randomized Controlled Trials. Italics: type of intervention.</p

Risk of bias across studies (all designs confounded, among RCTs only and among BA studies only) according to the Quality Assessment Tool for Quantitative Studies.

<p>Risk of bias across studies (all designs confounded, among RCTs only and among BA studies only) according to the Quality Assessment Tool for Quantitative Studies.</p

Patients’ perceptions of the importance of several domains related to the content of educational programs.

<p>Any two Bars with different shades of grey correspond to subdomains for which the scores were identified as significantly different by the multiple comparison procedure, whereas all bars with a given identical shade of grey correspond to subdomains for which the scores were identified as non-significantly different.</p

Scores attributed by patients for the explored modalities of information delivery.

<p>Within each dimension (What, Where, When, or How), any two bars with different shades of grey correspond to two items for which the scores were identified as significantly different by the multiple comparison procedure, whereas all bars with a given identical shade of grey correspond to items for which the scores were identified as non-significantly different. *Issued from the Wilcoxon-Nemenyi-MacDonald-Thompson test procedure. ^†Intermediate item: neither significantly different from “community pharmacy” nor from “Patient’s home” (n.b. the P value for the comparison of the two latters groups is 0.01). CI indicates confidence interval.</p

PRISMA flow diagram for the systematic review of regulatory and educational interventions to reduce the burden associated with the prescriptions of sedative-hypnotics in adults treated for sleep disorders.

<p>PRISMA flow diagram for the systematic review of regulatory and educational interventions to reduce the burden associated with the prescriptions of sedative-hypnotics in adults treated for sleep disorders.</p

Data items collected for studies included in the review.

<p>Data items collected for studies included in the review.</p

Scores attributed by patients for the explored modalities of information delivery.

<p>Within each dimension (What, Where, When, or How), any two bars with different shades of grey correspond to two items for which the scores were identified as significantly different by the multiple comparison procedure, whereas all bars with a given identical shade of grey correspond to items for which the scores were identified as non-significantly different. *Issued from the Wilcoxon-Nemenyi-MacDonald-Thompson test procedure. ^†Intermediate item: neither significantly different from “community pharmacy” nor from “Patient’s home” (n.b. the P value for the comparison of the two latters groups is 0.01). CI indicates confidence interval.</p

MOESM1 of An observational study of adult admissions to a medical ICU due to adverse drug events

Additional file 1: Table S1. Organ disorders associated with drugs implicated in adverse drug events

Prescribing errors before and after CPOE implementation.

<p>* Total number of drugs prescribed</p><p>Prescribing errors before and after CPOE implementation.</p